4 Ways to Register

	MAIL Mail registration information and payment to: Beckwith Electric Attn: Protection Seminar Administrator 6190-118th Ave. North Largo, FL 33773-3724
	PHONE Call 727.544.2326 and ask for the Protection Seminar Administrator.
	FAX Complete and Fax to: 727.546.0121. Attn: Protection Seminar Administrator
	ONLINE All items marked with the following symbol are required: Protecting your privacy is important to us! We will never use any of your identifiable information for any purpose without your consent.

Complete the first three questions if you are an administrator registering someone from your organization. If you are registering yourself, skip to the next section.
	Administrator Name (First/Last): Leave blank unless you are completing the form for someone else.
	Administrator Contact Number: Leave blank unless you are completing the form for someone else.
	Administrator E-mail Address: Leave blank unless you are completing the form for someone else.
Attendee Information:
	Organization:
	Name of Attendee (First/Last):
	Preferred First Name:
	Attendee E-mail Address:
	IEEE Member: No Yes
	If Yes, please enter your IEEE Membership Number:
	Attendee Phone:
	Address:
	Additional Address Info:
	City:
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	Zip Code/Postal Code:
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	I wish to have vegetarian lunches: No Yes
	Program Sessions: Monday, July 16 - Thursday, July 19, 2012 8 AM - 5 PM Welcome Reception: Sunday, July 15, 2012 7-9 PM Select One... Yes, I will attend. No, I can't make it. Not sure at this time. Hospitality & Demo Expo: Tuesday, July 17, 2012 7-10 PM No RSVP required. Hands-on Relay Setting and Testing Lab: Wednesday, July 18, 2012 7-9 PM Class size for this optional lab is limited, so register early to secure your place! Please bring your laptop to the lab. Select One... Yes, I will attend. No, I can't make it. Beckwith Electric Factory Tour: Friday, July 20, 2012 7:30-11:30 AM Transportation Provided From/To Hotel Select One... Yes, I will attend. No, I can't make it. Not sure at this time. Payment Options: Please select one: $1,225 per person by Friday, June 29, 2012. 10% group discount for 3+ attendees from the same company. Please note that all registrations must be made on the same day to qualify.   Check: Please mail a check payable to "Beckwith Electric" to the following address: Beckwith Electric Attn: Protection Seminar Administrator 6190-118th Avenue North Largo, Florida 33773-3724   Purchase Order #:   Other, Please Explain:   Credit Card: If paying by credit card, A representative will call you to obtain account information, or call 727.544.2326 and ask for the Protection Seminar Administrator. Questions/Comments: Press the "Register" button when you have completed the entire form.

Notice
Seminar information is subject to change. Check this website regularly to confirm seminar details. Beckwith Electric reserves the right to make changes in programs or speakers, and to cancel programs if enrollment criteria are not met. Beckwith Electric’s liability is limited to refund of registration fees.

Cancellation
Substitute attendees are welcome at no additional charge with prior notice.
15% cancellation fee applies if you cancel on or before June 15, 2012.
75% cancellation fee applies if you cancel between June 15 - June 29, 2012.
No refunds for cancellations after Noon ET on Friday, June 29, 2012.

IEEE Members
IEEE Members at time of registration are eligible for a discount. Please be sure to enter your IEEE member number in the registration form to receive this discount.