US Nuclear Corp.

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US Nuclear Corp.

Conference Attendee Registration

First Responders Congress
March 16-19, 2008
Hyatt Regency Hotel
Albuquerque, New Mexico USA

Please complete the following form to register to attend or exhibit during the premier First Responders Congress.

Click here to read the Conference Refund Policy before filling out this form.

CONFERENCE ATTENDEE INFORMATION

Your Full Name

Title

Company / Organization (Exhibitor Name)

Street Address

Suite / Apt.

City

State

Zip / Postal Code

Country

Telephone

Fax

Company / Organization Website Address

CONFERENCE REGISTRATION SELECTION (see details)

	Full Conference Pass (see details)	$100
	One-Day Pass (see details)	$50
	NRRPT Exam Review (see details)	$900

Total Amount Due:

SIGNATURE, PAYMENT, SUBMISSION

1. Due to the competitive FRC conference attendee rates, payment is required in full at the time of conference registration.

2. Cancellations must be made in writing. Please review the Conference Refund Policy for the cancellation policy.

SIGNATURE:

By filling in the following fields, the appropriate representative indicates that he or she has read, understands, and agrees to the Conference Refund Policy for sponsoring / exhibiting at the premiere First Responders Congress. Submission of this online contract constitutes a legal and binding agreement.

Your Full Name

Title

Date

PAYMENT METHOD

Credit Card	Visa MasterCard American Express (AMEX)
Card Number:
Expiration Date (mm/yy):
Name on Card:

Government Purchase Order
PO Number #
An invoice will be faxed to you.

Checks

Check #

Please make checks payable to "US Nuclear Corp."
Checks must be overnighted and received by March 14, 2008. Mail all check payments to:

US Nuclear Corp.
7051 Eton Avenue
Canoga Park, CA 91303 USA

Additiona questions?
Contact Tom Voss
tvoss@firstresponders.cc
(505) 920-1470

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