Miami Valley Society of Plastics Engineers


Name	*
SPE Number
Organization	*
Title
Address	*
	Home Work
City, State, Zip	*
Phone	*
Fax
Email	*
Credit Card Number	*
Exp Date	*
Card Type	Visa Mastercard AmEx
Cardholder Name	*
Number of Attendees	*
	Dinner is $25 per person
Notes
Date of Meeting
SPE Member Status	Member Non-Member

Please note that your card will not immediately be charged, nor validated and that filling this form does not constitute a credit card transaction. Information is sent only to MVSPE personnel.