Dixon CW CH Reg User Manual

Dixon
800 High Street Chestertown, MD 21620
410.778.2000 phone
410.778.4702 fax dixonvalve.com
Dixon Hose Coupling Workshop
Registration Form
Distributor Information:
Company Name: Street: City, State, Zip: Email: Cust ID (Internal):
Class Location:
Dixon Valve & Coupling Company 40 Chestnut Ave Westmont, IL 60559 Phone: 800-355-1991
Class dates: (This is a one-day workshop; please enter date in the following attendee table)
Tue – April 22, 2014 Wed – April 23, 2014 Thu – April 24, 2014
Attendees: Please Print Clearly for certificates & name tags
1.
2.
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6.
Cost per Student $50.00
(includes continental breakfast & lunch) Purchase Order # ______________________________ Authorized Manager: ______________________________
(please print)
Registration DEADLINE: Monday, April 7, 2014
Classes will be filled on a
first-come, first-served
Name
basis
Date
Requested
Please email to cnugent@dixonvalve.com or
fax to:
1-800-283-4966
Attn: Cherie Nugent
T-Shirt
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