11th Int'l LS-DYNA Users Conference  June 06-08, 2010






For Credit Card Payments - Fax Form

LS-DYNA International Users Conference -June 6-8, 2010
Classes are June 09-10, 2010
Hyatt Regency Dearborn, Dearborn, Michigan
 Credit Card Submission Form by Fax Only

 

1.  Credit Card:  Fill in the following form, print it and fax it to 925-961-0806
               We accept Master Card, Visa, AMEX - 

2.  Purchase Orders:  do not fill in this form - Send PO to:

Marsha Victory - LSTC - 7374 Las Positas Road,  
                             Livermore, CA, 94551 US

For questions contact Marsha at 925 449 2500 or vic@lstc.com 
Fields With * Are Required  FAX FORM TO:  925 961 0806
   
* Attendee's Name

 

* Cardholder First Name 

 

* Cardholder Middle Name 
      or  Middle Initial
 

 

* Cardholder Last Name

 

* Credit Card Number

 

* CC Expiration  month/year

 

* Company or University

 

*Telephone

Ext.

*For CC Receipt provide a fax #
    or e-mail address
    

*Email

*Total To Charge CC 

 

_______________________________

Signature on Card
   

 

____________________________

Date

Conference Only 
     Non Student   $450
     Student Rate w/ID  250		 Conference and Seminar
    Non Student    $900
     Student            $500
     
 Seminar Only 
    Non Student    $450
     Student Rate w/ID  250 		 

    FAX FORM TO:  925 961 0806

  .