2012 International Applied Reliability Symposium,
North America
June 13 - 15, 2012
New Orleans, Louisiana USA

ARS, North America
Symposium Registration - One Form Per Attendee
   Advanced Registration (must be received by April 20, 2012) 
   Standard Registration 
   Full-Time Student (Student ID Required) 

US$995.00
US$1195.00
US$495.00
Submit Registration
Phone: +1.520.886.0410                                        Fax: +1.520.886.0399
Mail: ReliaSoft Corporation, 1450 S. Eastside Loop, Tucson, AZ, 85710-6703, USA
Payment Method
 Company Purchase Order (attached, NET 30 basis)  Check or Money Order (payable to ReliaSoft Corporation)
 Credit Card (Vcode and credit card billing address are required. Please indicate billing address below or provide separately.)
Card Type:
  Visa MasterCard American Express

Card Number:
________________________________ Expires: _______ Vcode:
_______
Name on Card: ______________________________________________________________
Signature: ______________________________________________________________
Attendee Information Billing Information (if other than attendee)
Same as credit card billing address.  
Name: ______________________________
Company: ______________________________
Address: ______________________________
______________________________
Phone: ______________________________
Fax: ______________________________
E-mail: ______________________________
Same as credit card billing address.  
Name: ______________________________
Company: ______________________________
Address: ______________________________
______________________________
Phone: ______________________________
Fax: ______________________________
E-mail: ______________________________
Will you be attending the Hosted Dinner?  (check one) ____ With guest     ____ Without guest      ____ No
What size do you prefer for the complimentary polo shirt?   (circle one)     S     M     L    XL     XXL
Would you like to share your contact information with other participants? (check one) ___ Yes    ___ No
Additional Information
- Hotel Reservations: You will need to make reservations on your own. Please contact the hotel directly.
- Substitutions: Substitutions are allowed provided that ARS is notified 7 days prior to the Symposium start date.
- Cancellations: Cancellations received up to 15 working days prior to the Symposium start date will be entitled to a full refund of the registration fee minus a US$50 administration fee. After this period, all cancellations will be subject to the full fee.
- No Shows: Registrants who do not attend and do not notify ARS of cancellations are subject to the full registration fee.
- ARS reserves the right to cancel/reschedule the Symposium at any time up to 4 weeks prior to its start date. In the event of cancellation, all registration fees will be refunded. ARS is not responsible for any other charges, such as non-refundable airfare.
- Registration fee includes attendance to your choice of presentations; copies of the PROCEEDINGS and any other handouts; Hosted Dinner; daily continental breakfast; and refreshments during the breaks. A certificate of attendance: attendees are eligible for 1.5 CEUs and 1 CRP Course Credit.