Expo: November 14-15, 2012 | Conference: November 13-15, 2012
Pennsylvania Convention Center | Philadelphia, Pennsylvania
REGISTRATION FORM
To register for Filtration 2012, please complete the form below. Copy this form for additional registrations, or register
online at www.inda.org. By registering early you qualify for significant savings from the regular registration fee.
Name ___________________________________________________
(LAST NAME / SURNAME)
Title _____________________________________________
(FIRST NAME)
Organization ______________________________________________
Website __________________________________________
Address _____________________________________________________________________________________________________
City ________________________________________ State _________________ Zip _________________ Country _____________
Telephone ________________________________________________ Fax ______________________________________________
Email ____________________________________________________ Email Preference: q HTML
q Text
You must CHECK ONE answer in EACH SECTION for us to process your registration.
Your Organization’s Primary Affiliation with the Nonwovens Industry (check only one):
50
51
52
53
54
q
q
q
q
q
55 q
56 q
57 q
58 q
Roll Goods Producer/Supplier
Converters
End User of Nonwovens
Machinery/Equipment Manufacturer
Supplier of Binders, Chemicals,
Adhesives, etc.
Supplier of Fibers, Pulps, etc.
Supplier of Films, Tapes, etc.
Commission Services (e.g, Dyeing,
Finishing, Printing, Sewing, Slitting, etc.)
Research/Consulting
59
60
61
62
94
96
97
98
99
q
q
q
q
q
q
q
q
q
Paper/Packaging
Health Services
Transportation
Wholesale/Retail Distribution
Association
Academic Institution
Government
Press/Publishing
Other – specify:
__________________________________
I would be interested in appointments with the following suppliers (please check all that apply):
q New Business Development
q Adhesives/Binders/Sealants/Resins
q Laminate/Films
q Fibers
q Media/Membranes/Roll Goods
q Ultrasonic/Hot Melt/Welding
q Plastic/Additives
q Netting/Plastic/Metal
q Equipment/Testing/Measuring/Other
q Machinery/Pleating/Other
q Other
q Supplier of Fibers, Pulps, etc.
q Converting/Cutting/Coating
Registration Fees: (Check boxes & circle fees)
Through Oct. 15
INDA/NAFA
Primary Title or Job Function (check only one):
01 q Owner/Principal/CEO
02 q New Business Development
03 q Corporate and/or Division Management
04 q Plant Production Management
05 q Quality Control Engineering
06 q Research Development
07 q Purchasing
08 q Account Manager/Sales
09 q Consultant
10 q Other – specify:
__________________________________
11 q Marketing
12 q Engineer
13 q Financial/Accounting
14 q Office Manager/Administrative
15 q Human Resources
45 q Press/Editorial Staff
46 q Press Other Than Editorial
47 q Government
48 q Academic – Faculty
49 q Academic – Student
Oct.16 – Nov. 9
Non-
INDA/NAFA
Non-
After Nov. 9
INDA/NAFA
AIR TUTORIAL (Separate Fee Required)
Members
Members
Members
Members
Members
q Tuesday (9 a.m. – 12:45 p.m.)
$99
$139
$129
$169
$139
CONFERENCE & EXPO (Does not include air tutorial)
q 3-Day (Tues. PM, Wed., Thurs.)
$629
$879
$749
$1,049
$829
q Tues. PM q Wed. q Thurs.
$249
$339
$289
$409
$319
EXPO ONLY
$70
$70
$80
$80
$100
q 2-Day (Wed., Thurs.)
q Please check here if you have a disability that requires special assistance or accommodation to fully participate.
NonMembers
$179
$1,149
$449
$100
NOTE: Please attach a written description of your needs. INDA must receive all special assistance requests by October 15, 2012 in order to accommodate.
Payment: FULL PAYMENT MUST ACCOMPANY THIS REGISTRATION
q MasterCard
q VISA
Total Enclosed $ _____________
q AMEX
q Check / Money Order (in U.S. funds drawn on U.S. Bank, payable to INDA)
Card # ______________________________
Card Expires (Month): _______ (Year): _______
Signature: __________________________________________
q Wire Transfer (for instructions, please contact Tracie Leatham, tleatham@inda.org, or call 919-233-1210, ext. 126)
For all wire transfers, please reference Filtration 2012 and attach confirmation.
How Did You Hear About Filtration?
q Email
q Print Brochure
q Referral Friend/Colleague
Pre-register online at www.inda.org.
Or, mail / fax this form with payment
or credit card information to the
address / fax shown here >
q Print Ad
q Other (Specify)____________________________
Filtration 2012 / INDA
PO Box 1288, Cary, NC 27512-1288
Phone: 919-233-1210, ext. 126
Fax: 866-847-7922
tleatham@inda.org
NOTE: Cancellations must
be in writing and received by
INDA before Oct. 15, 2012.
No refunds for cancellations
received after Oct. 15, 2012.
EH