Registration - Henry Petroski Lunchoen on September 30, 2011 at 12:00 PM at St. Ambrose University
If you properly fill out and submit this on-line form, you should see a message that says "Thanks! Your response has been recorded". If you don't see this, you need to update or add  missing information which will be highlighted on the form in red color. A confirmation e-mail will be sent back to you within two days once your registration is successfully submitted.

For payment, you separately pay on-line by clicking on the "Donate" link on the webpage to pay by PayPal or credit card which is a secure transaction.  The amount you enter to "donate" should be the total amount for the number of people you registered for lunch x $12 each.

The information you submit will only be used by the QCESC and will not be redistributed or sold.
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Registration - Person 1
Name - Person 1 *
(Example John Smith)
E-mail Address *
Indicate which you are attending  - Person 1 *
(Lunchoen with Presentation for $12 each or Presentation Only which is Free)
Registration - Person 2
Name - Person 2
(Example John Smith)
Indicate which you are attending  - Person 2
(Lunchoen with Presentation for $12 each or Presentation Only which is Free)
Registration - Person 3
Name - Person 3
(Example John Smith)
Indicate which you are attending  - Person 3
(Lunchoen with Presentation for $12 each or Presentation Only which is Free)
Registration - Person 4
Name - Person 4
(Example John Smith)
Indicate which you are attending  - Person 4
(Lunchoen with Presentation for $12 each or Presentation Only which is Free)
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