Workshop Registration Form

Full Name:

Please type applicants name as it should appear on the fitter's diploma.
Title:
Length of Experience:
Company:
Address:
City:

State:

Zip Code:

Phone:

Fax:

E-mail Address:

Freeman Dealers:
Your account number is: 
Do you want the $150 registration charged to your account?   No Yes
If no, please make your check payable to:
Freeman Manufacturing Co.
P.O. Box J
Sturgis, MI  49091

Non-Dealers:
Method of Payment: 
Please make checks payable to:
Freeman Manufacturing Co.
P.O. Box J
Sturgis, MI  49091

Credit Card Information:
Card Account Number:
Card Expiration Date:
Name of Cardholder: