Frank Swierz Associates

21 Brad Court
Manchester, NH 03103

ph: 603-645-6001
fax: 603-250-0403

Registration

REGISTRATION FORM

NAME
_______________________________________
COMPANY
_______________________________________
ADDRESS
_______________________________________
CITY/STATE/ZIP
_______________________________________
PHONE
_______________________________________
EMAIL
_______________________________________

 

FEES/DISCOUNTS

Registration fees: $550 for the first registrant and $500 for all subsequent registrants from the same company.  Fee includes all conference materials, gift, lunch, reception and breaks.

Registration              Price                 Total

1st Registrant         $550                  _____

2nd Registrant       $500                 _____

3rd Registrant        $500                 _____

Spouse                         $99                     _____

Golf Tournament  $125                   _____

Golf Sponsor            $200/hole       _____

                                       Total Due         _____

 

METHOD OF PAYMENT

1.  Send payment by check in U. S. dollars and completed registration form to:

Frank Swierz
Frank Swierz Associates
21 Brad Court
Manchester, NH 03103

2. Wire bank transfer to:

Frank Swierz Associates
Citizens Bank
1500 South Willow Street
Manchester, NH 03103, USA
Account # 3304019547
Routing # 011500120
Swift Code: CTZIUS33

 

 

3.  Please charge my credit card

_____ VISA

_____ MasterCard

_____ AMEX

Card Number _______________________

Card Holder's Name ______________________

Expiration Date _________________________

Signature ______________________________

Card Billing Address______________________

_______________________________________

_______________________________________

Contact Tel: # ___________________________

 

TO REGISTER:

1. Fax Registration to: 603-250-0403


2. Mail Registration to:

Frank Swierz
c/o Frank Swierz Associates
21 Brad Court
Manchester, NH 03103, USA

3. Register on-line at: www.fswierz.com

 

For Questions, contact:

Frank Swierz at 603-645-6001 or email f.swierz@comcast.net

 

 

 

 

 

 

21 Brad Court
Manchester, NH 03103

ph: 603-645-6001
fax: 603-250-0403