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Registration FAX Application

4th Annual Practical Short Course

on

Water: Desalination, Process and Wastewater Issues & Technologies

(August 3-5, 2008)

Texas A&M University
College Station, Texas

Full Name:

(Full name as it will appear on your diploma)
Job Title:
Company:
Address:
City:
State:
Zip Code:
Country:
Business Phone:
Fax:
E-Mail:
Name Card:

(Name you would like to be called)
Contact
in case of emergency:

List any special
diet requirements:

Method of Payment (mark one):

Checks payable to TEES ( Texas Engineering Experiment Station)    

   and mail to TEES Fiscal Office, 3124 TAMU, College Station, TX 77843-

   3124

If paying with credit card please include type of card
Credit Card:
American Express Visa Master Card Diners Club
Credit Card Number:
Expiration Date:
Total Amount:
$
 
Signature:
 ____________________________________________________

Please type in your information above and print the form
OR

print the form and then write in your information and return this application to:

Cyndi Casanova

Short Course Coordinator

Food Protein R&D Center

The Texas A&M University System

2476 TAMU, 373 Olsen Blvd., Cater-Mattil Hall
College Station, Texas 77843-2476 U.S.A.

Phone: (979) 847-8997

Fax: (979) 845-2744

E-mail:  shortcourse@tamu.edu

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