Your Information -- NOTE:*means required for form to be processed. If one of the required fields do not apply to you, then fill in with "NA"

SSPC Membership Status:*	Member Non-Member	SSPC Individual Member ID Number
Last Name*		First Name*
Middle Initial		Social Security Number*
Title*		Company*
Company Address*		City*
State*		Zip*
Telephone*		Fax
Email*		Web Address
Approving Manager's Name		Manager's Title
Other Association Membership*		Education level, or other Certifications*

Demographic Information -- This must be completed, or we cannot process your application.

1. What kind of company do you work for? Check just ONE please.

A. Facility owner (end user of coatings) B. Industrial Painting Contractor C. General Contractor D. Specialty Contractor E. Concrete/Flooring Contractor F. Shop Fabricator G. Plant Fabricator (OEM) H. Architect, Engineering, Consulting I. Construction Firm J. Coatings Manufacturer K. Raw Materials Manufacturer L. Equipment Manufacturer M. Abrasives Manufacturer N. Coatings distributor, dealer or store O. Equipment distributor, dealer or store P. Research or Regulatory Agency Q. Residential Painting Contractor R. Commercial Painting Contractor S. Lead Abatement T. Residential Wallcovering Contractor U. Commercial Wallcovering Contractor V. Residential Restoration Contractor W. Commercial Restoration Contractor Y. Other (specify)

Only If you marked Facility Owner (1A above) do you need to answer this question 2. What is your industry? Check just ONE please.

A. Chemical processing B. Petroleum refining, processing distribution C. Metals and mining D. Pulp and paper E. Oil or gas production, offshore or land-based F. Conventional power G. Nuclear Power H. Railcar manufacturing and repair I. Bridge and highway J. Shipyard K. Waterfront, locks, dams L. Water works M. Waste treatment N. Food, pharmaceutical O. Equipment or vehicle manufacturing or maintenance P. Pipeline Q. Gas utility Y. Other (please specify)

3. In terms of coating work, what do you do? Check just ONE please.

A. Purchase or specify coatings B. Manage programs or projects C. Purchase or specify equipment D. Industrial hygiene or safety E. Environmental compliance F. Testing, research, formulating G. Sales and marketing H. Technical Service I. Executive management J. Applicator K. Blaster L. Regulator Y. Other (please specify)

Course Selection
		Member	Nonmember
	(C-1eCourse)	$495	$695
For more information contact Dee Boyle by email, Phone: 412-281-2331 ext. 202, or by Fax: 412-281-9993. NOTE: SSPC will honor discounts when you submit this form.

Select A Payment Option:

	Credit Card
	American Express   Mastercard   Visa
		Card Number
		Expiry Date:

Payment by Mail, Fax or Phone

Prepayment is required. Credit card orders may also be placed by phone, by fax or by mail to SSPC: The Society for Protective Coatings, 40 24th Street 6th Floor, Pittsburgh, PA 15222. Phone: 412-281-2331 ext. 202, Fax: 412-281-9993. Please provide the complete account number, account expiration date, and the cardholder's full name, signature, and telephone number. When mailing or faxing, please download this registration form, print it and include it with your payment. Mail orders can be prepaid by personal or company check, postal money order, certified check or bank cashier's check. All checks must be made payable to "SSPC" in US funds only.

A Free Membership Offer from SSPC

If you register for a Training course at the nonmember rate, you join SSPC as an individual member at no additional cost to you. Your membership includes a subscription to the "Journal of Protective Coatings & Linings". We will process your application, and you will receive your membership card and JPCL magazine shortly thereafter. This offer is valid only for new members or those whose membership has been inactive for at least six months.

Cancellation/Refund Policy

If SSPC receives written cancellation in 16 or fewer days before the training, you will receive credit towards a future conference or training event, minus a $50.00 service charge. If you do not enroll in another class within one year, the fees will be forfeited. If you do not cancel, you are still responsible for the payment. If the distance learning class is canceled by SSPC, registrants receive a full refund of payments. SSPC reserves the right to cancel the registration of a student at any time for just cause. The cause may include, but is not limited to, sending inflammatory messages through Coatings-talk or Training Talk; cheating; sharing your C-1 password; and misrepresenting your identity or affiliation in e-mail communications. Non-Participation in C-1 for which you have registered does not constitute cancellation or withdrawl and will result in a failing grade with no financial refund.