REGISTRATION FORM   -- CLEARWATER CLEAN COAL CONFERENCE

(Return with payment) – or call with credit card information to avoid filling out the form

37^th International Technical Conference 

on Clean Coal & Fuel Systems

June 3 to 7, 2012

Sheraton Sand Key

Clearwater, Florida, USA

Name_______________________________________________

First Name for Badge__________________________________

Title________________________________________________

Company____________________________________________

Address_____________________________________________

City__________________________State_______Zip________

Country_____________________________________________

Phone_______________________________________________

FAX________________________________________________

Email_______________________________________________

Registration Fee:       $____________

OPTIONAL EXTRAS:

Field Trip (6/10/11) to Polk Power Plant         $150.00

Spouse's Fee :                                                   $150.00

Spouse's Name_______________________________

 

 

GRAND TOTAL (Registration plus Extras): $___________

 

Wednesday Themed Luncheon: 

Seat me at _____________'s Table on ___________________

 

I understand that if photography any materials offered in any conference session that I will be asked to leave the conference and forfeit my registration fee.

  The registration fee covers one CD-Rom of the Proceedings, all conference events (Sunday through Thursday (excluding the Polk trip), the Exhibit Center, 4 luncheons, 2 evening parties, all breaks, all Continental breakfasts, and all conference materials.

Method of Payment; Check One:

 Check enclosed (payable to CTA; remit to 12548 Granite Ridge Dr., North Potomac, MD  20878); or

 

 VISA No._________________________________________________________________

 

 MasterCard No.___________________________________________________________

 

American Express No. __________________________________

Discover No. __________________________________________

Credit Card Expiration Date: _______________________________

Name of Cardholder:______________________________________

Address of Cardholder: ___________________________________

_______________________________________________________

Signature:_______________________________________________

 

ð  Send information about the Exhibit Center.

 

Spouses Registration - With so much to see and do in the Clearwater area; we don't plan specific activities for spouses.  However, the $150 fee covers the Welcome Party, four luncheons, beach party, Continental breakfasts and all refreshment breaks.  Keep in mind, the on-site spouse's registration is $175.

 

Student Registration -- To encourage participation by full-time students currently enrolled in a college or university, the Conference Committee is offering a registration fee of $395. 

Cancellations received in writing by May 10th will be refunded in full, less a $25 administrative charge.  Cancellations received after this date will not be refunded.  Substitutions are welcome at any time.   Fees paid by speakers are not eligible for refunds.

You may email your information to BarbaraSak@aol.com; call 301-330-2256 and we'll register you over the phone; or mail the form along with your check to CTA.

CTA reserves the right to modify the Conference Program at any time  

36^th International Technical Conference

on Clean Coal & Fuel Systems

The Clearwater Clean Coal Conference

Barbara Sakkestad

12548 Granite Ridge Drive

North Potomac, MD  20878

301-330-2256

barbarasak@aol.com

www.coaltechnologies.com