Dixon Valve CW CH Reg April 2014 User Manual
Dixon hose coupling workshop registration form
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
Classes will be filled on a
first-come, first-served
basis
Attendees: Please Print Clearly for certificates & name tags
Name
Date
Requested
T-Shirt
Size
1.
2.
3.
4.
5.
6.
Cost
per
Student
$50.00
(includes continental breakfast & lunch)
Purchase Order #
______________________________
Authorized Manager: ______________________________
(please print)
Registration DEADLINE: Monday, April 7, 2014
Please email to
or
fax to:
1-800-283-4966
Attn: Cherie Nugent