First Name	Press and Media Registration
	Last Name
	Title
	Company
	Address
	City
	State
	Zip
	Phone
	Email
	Spouse Information
	First Name
	Last Name
	Payment Information
	Registration Fees
	Golf Tournament	(Please enter $0 if you will not be joining the tournament)
	Credit Card Type	Visa MasterCard Discover American Express
	Credit Card Num
	Exp Date
	3-digit Security Code	*Required for Mastercard transactions
	Comments

Questions and Comments: If you have any questions regarding event registration,
please contact Jim Feldhan at Semico Research Corp at 602-997-0337.
There are no refunds for "no shows".  Cancellations must be received in writing and faxed to 602-997-0302 one month prior to event date in order to receive your full refund
(minus transaction fee of $25.00).