Shock Seminar
Registration Form

Print this form, fill it out and fax or mail to:
Naake Suspension Specialists
2300 Central Ave
Roseville, CA  95747
(916) 771-0109 Phone
(916) 771-5201 Fax

I wish to register for:

(Please check one or both)


___ Ohlins Shock Seminar on Jan. 8, 2005
       9:00am - 5:00pm
       Early Registration $195, After 12/23/04 $250 

___ QA1 / Carrera Shock Seminar on Jan.  9, 2005
      8:30am - 12:30pm
      Early Registration $75, After 12/23/04 $95

 
Name of Contact Person:
 __________________________________
Name of Attendee:
 __________________________________
Name of Attendee:
  __________________________________
Name of Attendee:
  __________________________________
Total Number of Attendees:
  __________________________________
Race Team:
  __________________________________ 
Address:
  __________________________________
   __________________________________
Phone #:
  __________________________________
Fax #:
  __________________________________
Payment Method:
     __ Sending a check         __Credit Card
Credit Card #:
  __________________________________
Expiration Date:
  __________________________________
Card Name:
  __________________________________
Will you be staying at the Oxford Suites?:
                     YES      or        NO