2004 ECCO Seminar Registration Form

Please complete the information requested below. You do not have to send your Credit Card information this year. Completed registration forms should be sent to your 2017 ECCO Treasurer, [email protected].

Once I will receive you registration form, I will send you a “PayPal” Invoice that will allow you to pay on- line with your own Credit Card. You do NOT have to have a PayPal account to pay.

Name: _

Affiliation:

Address:

City: State: Zip:

Phone: ( ) - Fax: ( ) -

Em ail wh ere yo u w ant th e invo ice t o b e sent :

Name Preferred on Badge:_ _ _ Do you need special assistance to participate in this meeting? Yes No I f s o, an E CCO r ep r e s e n tat i ve w ill c onta c t y ou.

Registration Fees

$450 Meeting Fee (until March 19, 2017) $500 Meeting Fee (after March 19, 2017)

Tax ID and Non-Profit Identification: Export Control Coordinators Organization. Tax ID# 82-0529967 – Texas Non-Profit ID#320487269421.

If you would rather send a check:

Mail your form and check to: Pacific Northwest National Laboratory Attn: Kimberly Galloway P.O. Box 999, MS: K8-50 Richland, Washington 99352 Your registration and payment are requested by March 20, 2017 You may also fax a copy of your registration form to (509) 375-2006, attention Kim. Please contact Kimberly Galloway by e-mail [email protected] or by phone at (509) 372- 6184 if there are any questions concerning the payment of registration fees.