Dixon Valve KC CW 2014 - 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 Kansas City Branch
1244 Saline Street
North Kansas City, MO 64116
Phone: 816-221-0064
Class dates: (This is a one-day workshop; please enter date in the following
attendee table)
Tue – May 6, 2014
Wed – May 7, 2014
Thu – May 8, 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
and all class materials)
Purchase Order #
______________________________
Authorized Manager: ______________________________
(please print)
Registration DEADLINE: Monday, April 21, 2014
Please email to [email protected] or
fax to:
1-800-283-4966
Attn: Cherie Nugent