Registration Form

ENERGY WORKSHOP REGISTRATION FORM
CLE CREDIT APPLIED FOR

INDIEC and Energy: Shaping the Future
May 17, 2002
The Capital Conference Center Auditorium
201 N. Illinois Street, Indianapolis, Indiana

Registration Information:

Cost	Indiec Members $125 - Non-Indiec Members $175
Accommodations	Call Marriott Courtyard (317) 635-4443
Cancellation/Refunds	Refund requests will be reduced to a fee of $50. Substitutions are welcomed and encouraged at no charge. Please contact Kay Squires to designate a substitute.

There are FOUR easy ways to register:

MAIL this registration (with check payable to "INDIEC" to Kay Squires, Lewis & Kappes, 1700 One American Square, P.O. Box 82053, Indianapolis, IN 46282.

FAX this registration with credit card information to Kay Squires (317) 639-4882

WEB SITE Complete the Energy Workshop Registration Form below and submit using secure SSL transaction.

CALL Kay Squires (317) 639-1210 (be prepared to give credit card information)

Method of Payment:

CHECK payable to INDIEC will be mailed to Kay Squires c/o Lewis & Kappes, P.C. 1700 One American Square, P.O. Box 82053, Indianapolis, IN 46282-0003

CREDIT CARD PAYMENT

Visa MC Discover AmEx

Name of Cardholder
Account Number
Expiration Date

Registration Form:

Name of attendee(s)

Company

Street Address

P.O. Box

City State Zip

Telephone

Fax

E-Mail

Please send confirmation regarding this matter.

	MAIL this registration (with check payable to "INDIEC" to Kay Squires, Lewis & Kappes, 1700 One American Square, P.O. Box 82053, Indianapolis, IN 46282.
	FAX this registration with credit card information to Kay Squires (317) 639-4882
	WEB SITE Complete the Energy Workshop Registration Form below and submit using secure SSL transaction.
	CALL Kay Squires (317) 639-1210 (be prepared to give credit card information)

	CHECK payable to INDIEC will be mailed to Kay Squires c/o Lewis & Kappes, P.C. 1700 One American Square, P.O. Box 82053, Indianapolis, IN 46282-0003
	CREDIT CARD PAYMENT

Name of attendee(s)
Company
Street Address
P.O. Box
City State Zip
Telephone
Fax
E-Mail

Return to Home