Short Course on Corrosion
Fundamentals and Experimental Methods
June 7-12, 2009
Penn State University Park Campus, State College, Pennsylvania
This form may be duplicated for additional registrations. Please print in ink or type.
Return to Penn State by May 11, 2009.
Last Name / First Name / Middle InitialSocial Security No. / Title
Male Female / Email
Company or Organization
Business Address
(No. and street or box no.)City / State / Zip Code / Country
Business Phone / Home Phone / Fax
Home Address
(No. and street or box no.)
City / State / Zip Code / Country
Please fill out the following information:
Check here if you would like to have internet access through PSU computer labs while on campus:
What type of corrosion related business are you in?
Please list the lecture topics of most importance to you:
T-shirt size
Small Medium Large Extra Large
Corrosion short course t-shirts are provided for participants.
Method of Payment
Your payment, in full, must accompany your registration form. Fax or telephone registrations must be accompanied by credit card payment information
Fee: $2300.
Enclosed is a check for the amount indicated, payable to Penn State
IDCC – Penn State employees only to &CNI. (A completed registration form is required to process your registration.)
Enclosed is a purchase order (made payable to Penn State) or letter of authorization from employer or organization.
Charge the fee I have checked to my credit card.
To pay by credit card you must call 1-800-PSU-TODAY (778-8632) and process your credit card over the phone after sending this form.
Please check here if you have ever been enrolled in a degree-granting program at Penn State.
Before mailing:1. Complete all information
2. Sign check and make payable to Penn State.
3. Where appropriate, indicate all conference preferences and fees.
4. If paying by credit card, you must call 1-800-PSU-TODAY (778-8632) to process your order. / Send To:
Conferences and Institutes Registration
The Pennsylvania State University
Box 108
State College, PA 16804
Fax (814) 863-5175
(Complete information and payment are necessary for registration)