TRAINING REGISTRATION

PLEASE COMPLETE THE FORM AND FAX TO FIELDBUS INC. AT 512-794-3904
Registration deadline for each workshop is FOUR WEEKS prior to the workshop date.

WORKSHOP PARTICIPANT INFORMATION

Student Name _____________________________   Company Name _________________________________

Postal Address _____________________________________________________________________________

Phone ________________________  E-Mail______________________________________________________

PAYMENT OPTIONS (check one):

Check should be mailed to Fieldbus Inc. : 9390 Research Blvd. Ste. I-350, Austin, TX 78759

Wire transfer: please call us at 512-794-1011 for wire transfer information

Credit Card Visa ___ MasterCard ___ American Express ___

    Card Number _________________________ Exp. Date __________

    Cardholders Name _________________________________________

CANCELLATION POLICY - There will be no cancellation fee if you cancel your registration in writing more than 28 days prior to the workshop. Written cancellations received 7 to 14 days prior to the workshop are subject to a 50% cancellation fee. Written cancellations received 7 or fewer business days prior to the workshop are subject to a 100% cancellation fee. Substitutions may be made at any time prior to the workshop, however a new registration form must be completed. FI reserves the right to cancel the workshop 14 days prior to the workshop.

CERTIFICATION
I have read and understand the terms and conditions of Fieldbus Inc. cancellation policy and payment terms.