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Power Meeting Registration: Step 1 of 3

Please complete this form to register for the Power Meeting.
Upon submitting this form, you will be automatically redirected to a second page to continue your registration.

Badge Name #1: (Required)
Badge Name #2:
Badge Name #3:
Badge Name #4:
Company: (Required)
Address: (Required)
City State ZIP: (Required)
Phone: (Required)
Fax:
E-mail: (Required)
If you will be bringing a guest (or multiple guests) to either the opening or closing receptions*, please enter their names here: * There is a fee of $40 for each guest at each reception. Please enter the number of guests on the next screen.	Opening Reception Guests: Closing Reception Guests:
Apply Free Registration Coupon:
This is my first Power Meeting:	Yes
Please send me more information about QSC membership:	Yes
Check here if you require special accessibility or accommodations to fully participate in the functions. Please fax a written description of your needs to QSC (703) 237-7442.
Check here if you require special dietary requirements. Please fax a written description of your needs to QSC (703) 237-7442.
people will be attending the Golf Tournament (Optional) send information..
people will be attending the Roundtable (Optional) send information..

Refund Policy:
Cancellations on or before Feb. 17, 2012, will be charged a $75 cancellation fee. NO refunds will be made for cancellations after Feb. 17, 2012. Remember, attendee substitutions are always permitted at no charge.

Questions? Contact QSC at: Phone (800) 533-7694, (703) 237-8100, Fax (703) 237-7442