PINE Registration Form
Please complete the registration form to facilitate getting information to PINE staff for upcoming education and training courses and special seminars. A PINE staff member will contact you directly regarding the most convenient payment method. Contact Christine Hagopian at 508-804-4152 or with any questions or for further information.
* Indicates a required field
* Name:
* E-mail:
* Title:
* Company:
Address:
City:   State:  Zip:
* Phone: (ie: 5557779090) Fax:
PINE offers a 100% money-back guarantee on all programs
Charge my credit card PINE members only — Please send me an invoice.
Card Type: Visa Mastercard Amex Discover (Note: This is not a secure connection - you may call Christine Hagopian at 508-804-4152 to provide your credit card number or complete and print this form and fax it to PINE at 508-804-4119)
Account #:
Expiration Date:
Cardholder Name:
Billing Address for Credit Card is:
Addtional registrants:
* Is your firm a member of PINE? Please type 'yes' or 'no' here: (required)
Please send me information on membership
Program:	$280 per person
Would you like an e-mail confirmation of your registration? yes no