n o v/d e c • 2 0 0 8 - Subscribe

REGISTRATIoN INFoRMATIoN p PDCA Member p SSPC Member p Not a Member
PLEASE PRINT CLEARLY - ONLY ONE NAME PER REGISTRATION FORM MEMBER # _________________________________
First Name/MI Last Name
Nickname (for your badge)
Title Department/Division
Company Name
Address
City State/Prov Zip/Postal Country
Phone Number Fax Number
E-mail Address Web Site Address
Emergency Contact Phone
A. SELECT YouR PACE CoNFERENCE PACKAGE
*Please Check Box(s) for Registration Below Early Bird Full Price
by 1/30/09 after 1/30/09
o (1MF) Member (PDCA or SSPC) Full Conference $539 $639
o (1MA) Member Additional Employee $439 $539
o (1NF) Non-Member Full Conference $720 $820
o (1NA) Non-Member Additional Employee $620 $720
o (3OM) Member One Day Registration – no banquet $245 $245
Choose Day: m Sun m Mon m Tue m Wed
o (3ON) Non-Member One Day Registration – no banquet $345 $345
Choose Day: m Sun m Mon m Tue m Wed
o (5TN) Three day Exhibit Hall Only (incl. lunch Tue & Wed) $150 $150
o (7EO) Single Day Exhibit Only $60 $60
Choose Day: m Mon m Tue m Wed (incl. lunch Tue & Wed)
o (9SP) Guest/Spouse Registration (incl. lunch - no banquet) $150 $150
o (9CH) Children 16+ (incl. lunch - no banquet) $50 $50
o (2YC) Emerging Leaders Full Conference -$0- -$0-
o Yes, I will attend the Emerging Leaders Program
Birth Date: ____ / ____ / ____
Company Owner Name: ____________________________
Relationship to Owner: ____ Son/Daughter ____ Son-In-Law/Daughter-In-Law
B. SPECIAL EVENTS/oPTIoNAL PRICE QTY. TOTAL
o (HA1) Habitat for Humanity Volunteer (Fri. 2/13/09)** $50 _____ _____
o (HA2) Habitat for Humanity Volunteer (Sat. 2/14/09)** $50 _____ _____
o (REC) Welcome Reception (Sun. 2/15/09)* $45 _____ _____
o (CAJ) Cookin’ Cajun (Tue. 2/17/09) $55 _____ _____
o (UC1) Union Contractor Program (Tue. 2/17/09) -$0- _____ _____
o (PD4) Pro Faux Certification (Wed. 2/18/09) $189 _____ _____
o (BAN) Club5 Tickets (Wed. 2/18/09)* $95 _____ _____
*The Welcome Reception & Club5 are included with full conference registration. If you do not
register for a full conference, you must purchase additional tickets to attend either event. **Habitat
for Humanity Volunteer is strictly a volunteer opportunity. The entire fee goes toward the Leukemia
& Lymphoma Society and the PDCA Disaster Relief fund in place of proceeds from the former PACE
auction. All fees collected are tax deductible as far as the law allows – please consult your tax
advisor.
C. PDCA TRAINING & EVENTS
Training attendees will receive a $100 discount when purchasing a PACE 2009 Full Conference
registration. If you have any questions regarding Training, please contact your association.
Member Non-member
o PACER Training (Pick 1: o (PD1) Sat. 2/14/09 o (PD3) Sun. 2/15/09) $100 $200
o (PD2) PDCA Contractor College Pre-Convention Education (Sat. 2/14/09) $200 $300
o (PDC) PDCA Awards Luncheon (Mon. 2/16/09)* Complimentary
*Although the luncheon is complimentary for registered PDCA attendees, you must check this box to receive a ticket.
NOTE: By registering for the conference you are consenting to receive written and
verbal communication from PACE, SSPC, and PDCA via postal mail, courier, telephone,
fax, and e-mail.
p No. PACE may not provide my information to PACE 2009 exhibitors
BOX A
REGISTRATION
SUBTOTAL
$ _____________
BOX B
SPECIAL EVENTS
SUBTOTAL
$ _____________
BOX C
PDCA TRAINING
SUBTOTAL
$ _____________
DEMoGRAPhICS
What type of company do you
work for?
p A. Architect, Consultant,
Engineer
p B. Commercial Contractor
p C. Fabricator
p D. Facility Owner/End User
p E. Industrial Contractor
p F. Manufacturer
p G. Residential Contractor
p H. Supplier
p I. Other ________________
What kind of work do you do?
(check all that apply):
p A. Manager/Supervisor
p B. President/CEO/Owner
p C. Purchasing
p D. Safety, Compliance
p E. Sales & Marketing
p F. Testing, Research
p G. Technical Service
p Y. Other
_________________________
D. SSPC TRAINING
Training attendees will receive a $100 discount when purchasing a PACE 2009 Full Conference
registration. If you have any questions regarding Training, please contact your association.
Member Non-member
o (PRO) Project Management $595 $795
o (ATT) Applicator Train-the-Trainer Program $795 $995
o (C1) Fundamentals of Protective Coatings $995 $1,195
o (C2) Specifying and Project Management $995 $1,195
o (C3) Lead Paint Removal * $995 $1,195
o (C5) Lead Paint Removal Refresher * $395 $595
o (C7) Abrasive Blasting Program $795 $995
o (C10) Floor Coating Basics $595 $795
o (C12) Airless Spray Basics $595 $795
o (TS) Thermal Spray Basics (Sat. 2/14/09) $395 $595
o (MC) Marine Coatings $995 $1,195
o (BC1) Bridge Coating Inspector Training $995 $1,195
o (BC2) Bridge Coating Inspector Certification $1,395 $1,595
o (NBP) NAVSEA Basic Paint Inspector Course $1,095 $1,295
o (PCA) Protective Coatings Inspector Training $995 $1,195
o (PCB) Protective Coatings Inspector Certification $1,395 $1,595
o (QCS) Quality Control Supervisor $595 $795
o (CS1) Coating Application Specialist Written Exam (Thu. 2/19/09) $175 $275
o (CS2) Coating Application Specialist Hands-On Exam (Thu. 2/19/09) $175 $275
o (PC1) PCS Exam (Mon. 2/16/09) $500 $700
o (PC2) PCS Exam (Thu. 2/19/09) $500 $700
o *(SMD) Maryland state supplement (C3 or C5) $25 $25
o *(SVA) Virginia state supplement (C3 or C5) $25 $25
o (PDA) Intro to Polyurea for the Applicator and Contractor Contact PDA for Pricing
PLEASE CHECK THE PROGRAM FOR DATES AND TIMES OF
TRAINING COURSES.
PACE CANCELLATIoN PoLICY:
Cancellations must be received in writing by December 28, 2008 to
qualify for a 100% refund, less $50 administrative fee. Cancellation
requests received after December 28, 2008 and by January 11,
2009 will receive a 50% refund. NO REFUNDS WILL BE GIVEN
AFTER January 11, 2009 OR FOR NO-SHOWS.
E. TRAINING DISCouNT
Less $100 Discount for Training Course registrants ONLY
*Training Discount applies only when purchasing a full conference registration PLUS training
F. PAYMENT
To calculate your amount due, add the totals in boxes A - E. This is your total registration cost.
Select a payment option: p American Express p MasterCard p Visa p Discover
Exp. Date ____ / ____ Card Number ______________________________________
Signature (Required) ______________________________________________________
What is your age range?
p A. 18 - 25
p B. 26 - 35
p C. 36 - 45
p D. 46 - 55
p E. 55+
Are you responsible for
purchasing decisions?
p YES p NO
Are you prepared to make
a purchasing decision on site?
p YES p NO
SPECIAL
NEEDS/DIET:
p I need special assistance
p I have special dietary needs:
o (L) low sodium
o (D) diabetic
o (V) vegetarian
o (K) kosher
o (X) other
______________________
BOX D
SSPC TRAINING
SUBTOTAL
$ ______________
BOX E
TRAINING DISCOUNT
$ ______________
TOTAL COST
BOX A+B+C+D-E
Print Name ______________________________________________________________
$ ______________
p Check enclosed (Payable to “PACE 2009”)
NOTE: When registering for PACE you are authorizing the use of any photographs taken onsite for future promotions.
2 EASY WAYS To REGISTER IMPORTANT: FULL PAYMENT IS REQUIRED AT THIS TIME.
-- U.S. FUNDS ONLY--
ON-LINE: www.PACE2009.com
MAIL TO: PACE 2009, c/o QMS Services Inc., 6840 Meadowridge Ct., Alpharetta, GA 30005