REGISTRATION FORM

First Name

Last Name

Address

City

State

Zip

Phone

E-Mail

PTG Chapter

Payment Method:

Name on account used for payment:

The PHP handler is not working; so the Submit button doesn’t work. You may:

1. Print completed form as a PDF file, and email to

or:

2. Save file to your device, then email it to the above email address.

or:

3. You may also print the page, then mail it to the treasurer (address on registration page)

Pomona Valley Chapter Piano Technicians Guild

Bill Shull, Director, Eric Mrozek, Registrar

November 17-19, 2023