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Name: * Title: * Organization: * Email: * Phone #: * Address: * City: * State: * Zip Code: * Comments: Payment Registration amount for the event is $50 Date and Time Wednesday, December 10, 2008 1:00 p.m to 5:00 p.m Venue Westin Galleria Hotel Plaza Ballroom 5060 W. Alabama St. Houston, TX 77056 For Directions Click here A.I.C.P. credits will be awarded for conference participation. Please make checks payable to Corporation for Regional Excellence and reference “CSS Workshop” in the memo section. For more information, call Meredith Dang at 713-993-2443 Billing Information Billing Name Billing Address 1 Billing Address 2 Billing City Billing State AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Billing Zip Payment Payment Type Mastercard Visa Check Card Number CVV Number Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Total: $50.00