Technition Alignment Training Clinic Registration

Please remit your Annual Dues by June 15, 2019, together with the completed form (below).  For your convenience, please remit your annual dues to:

1035 Blackburn Circle
Libertyville, IL  60048


Any questions? Contact Gordon Botts at:

***Please fill-out, detach and return***

Company Name: ________________________________________________

Amount enclosed: _____________

I would like to host a Technician Training Clinic: ______

I would like to send technicians to one or both programs: ______

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