Please provide the following contact information (*Fields are required):

*Name
Title
*Organization
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Country
*Work Phone
Home Phone
FAX
*E-mail

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Which program do you wish to sign up for:

              Choose package 6 events - $3,000 8 events - $4,000 16 events - $7,000 all events - $10,000   If you chose a package with 8 cities, also choose

                                               one post-event reception; if you chose 16 or all

                                               cities, also choose two post-event receptions.

Choose the cities you wish to include (do not check more than the package allows):

	PROFIBUS DP	PROFIBUS PA	PROFINET
February
March	Grand Rapids March 27	Augusta March 6	Kansas City March 15
April	Salt Lake City April 2	Mobile April 10	Atlanta April 3
May	Nashville May 1	Boston May 9	St. Louis May 2
June	Gary, IN	Richmond	Montreal Toronto
July	Des Moines	Edmonton	Denver
August		Houston	Austin
September	Dallas	London, ON	Detroit
October	Columbus, OH	Kansas City	Richmond
November	Philadelphia		New York City

                  Exact dates are available at least 30 days prior to the event.

_______________________________________________________________

Choose the cities for which you want to sponsor a post-event reception:

	PROFIBUS DP	PROFIBUS PA	PROFINET
February
March	Grand Rapids	Augusta	Kansas City
April	Salt Lake City	Mobile	Atlanta
May	Nashville	Boston	St. Louis
June	Gary, IN	Richmond	Montreal Toronto
July	Des Moines	Edmonton	Denver
August		Houston	Austin
September	Dallas	London, ON	Detroit
October	Columbus, OH	Kansas City	Richmond
November	Philadelphia		New York City

_______________________________________________________________

Please provide the following billing information (*Fields are required):

*Name
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
Country
*Phone
*Amount to be billed