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Please Complete and Submit. For questions call 1-800-209-8266 or fax 781-395-0634

NAME  PHONE  EXTENSION

TRADE ASSOCIATION NAME

HOME ADDRESS

CITY/TOWN  STATE   ZIP

BUSINESS NAME   PHONE   EXTENSION

BUSINESS ADDRESS

CITY/TOWN    STATE      ZIP

EMAIL ADDRESS CHECK BOX IF YOU WOULD LIKE A RECEIPT EMAILED TO YOU

SPOUSE/COMPANION OR CHILDREN ATTENDING
(LIST ALL NAMES):

Deadline for registration is Oct. 15, 2010. Registration before this deadline is free.
You must be registered to attend classes and the trade show. Forms received after
Oct. 15, 2010 require a $10 per person registration fee.

TOTAL PERSONS TO BE REGISTERED  SELECT NUMBER NONE ONE TWO THREE FOUR FIVE SIX SEVEN EIGHT NINE TEN ELEVEN TWELVE THIRTEEN FOURTEEN FIFTEEN SIXTEEN SEVENTEEN TWENTY POST-DEADLINE LATE FEE (IF ANY) $

                                                                                           TOTAL amount due $ (no cents)

Or "please charge my credit card".

Master Card #   Visa Card# Expiration Date

Payment must accompany registration.
I hereby certify that the above listed applicant: 1) works or is employed in the security industry; 2) has not been convicted of a felony; and 3) will not use the information or training received for any improper purpose. I will indemnity and hold harmless Yankee Security Convention, Inc. and it's directors or officers. I also will allow the usage of my photo for Yankee Security promotional purposes.

Signature (type in your name)    Date (month/day/year)
Repeat     (type in your name)

We will process your registration, and, if received early enough, your package will be ready at the registration desk when you arrive.

SUBMIT YOUR COMPLETED FORM    (Click once)