MicroRite, Inc. :: microbiology | quality


			Cleanroom Microbiology
			Contamination Control
			Environmental Monitoring
			Disinfectant Qualification and Cleaning Procedures
			Fungal Identification

Personal Information of One Registrant

Last Name*:

First Name*:

Title*:

Organization*:

Mailing Address*:

City:

State:

Zipcode:

Telephone*: (Area Code)

Fax*: (Area Code)

E-mail*:

Name of Person Paying by Credit Card*:

Days:

Day 1	Day 2	Both Days

Fees:

Day 1: $950.00 (US)

Day 2: $950.00 (US)

Both Days: $1800.00 (US)

Group Discount:

10% discount for each attendee when 4 or more attendees register for any one seminar

Additional Attendees:			Day 1	Day 2	Both Days
Last Name:	First Name*:	Title*:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:
Last Name:	First Name:	Title:

Method of Payment: Check, Credit Card or Purchase Order
Fax : 408-445-1236

Checks payable to Microrite, Inc.
5019, New Trier Avenue
San Jose, CA 95136

Confirmation of registration will be sent via email.

Cancellation Policy: Your notice of cancellation must be received by in writing by letter,
facsimile or email 10 working days prior to the Seminar date. Fax: 408-445-1236 Email:
sales@microrite.com or zabraham@microrite.com
A 10% cancellation fee is applicable for credit card payments