Company Name:________________________________________________________________________________________________ Name:___________________________________________ E-mail:_______________________________________________ Mailing Address:____________________________________________ City:_____________________________________________ State/Province:________________________________ Zip/Postal Code:_____________ Country:__________________________ Telephone:_____________________ Fax:____________________ Website:_________________________________________ Member of: State Association(s):___________________________________________________________________________________ Are you involved in? Const./Geotech. ___ HDD ___ Env. ___ Expl./Blast ___ Geothermal ___ Shallow Gas/Oil ___ Min. ___ Water ___ Badges: (Please list every attendee as you wish their name badges to read. Attach a separate piece of paper for additional names.) Name:____________________________________________ Name:______________________________________________ Company:_________________________________________ Company:___________________________________________ Name:____________________________________________ Name:______________________________________________ Company:_________________________________________ Company:___________________________________________ How many? Badge Type Cost per badge Total Owner / Contractor / Manager (MAIN REGISTRANT for Company) $100 $100 Spouse / Children (12 and under) $0 $ N/C ALL other registrants of the same company $25 $ Student (with current Student ID) $25 $ How many? Event Price Total Wednesday Ladies’ Day Excursion $35 per person $ Wednesday & Thursday Informative Sessions Eight (8) CEUs Available ALL are welcome - if you need CEU credits, there is a $35 charge per course $ SEE PAGE 33 after this Insert FOR HOTEL RESERVATION INFORMATION / RV accommodations. *CONCESSIONS / BAR will be available on-site. (NO outside food or beverages permitted.) WorldWide DownHome DrillFest™ 2023 ATTENDEE REGISTRATION 850-547-0102 October 17-19, 2023 Ozark Empire Fairgrounds & Event Center, Springfield, MO SUBSCRIPTION REQUEST to MONTHLY ISSUES OF WorldWide Drilling Resource® MAGAZINE Please include me for a monthly subscription to WorldWide Drilling Resource® magazine and charge my credit card above. $ Grand Total Method of Payment: American Express Visa Master Card Discover Card Card #:_____________________________________________ Security Code #:________ Expiration Date:_________ Printed Name:________________________________________ Card Billing Address: __________________________________________________________________________________________ ___________________________________________________________________________________________________________ Signature:___________________________________________ Date: ______________________________________ I agree to be responsible for all registrants included with my company for adherence to Ozark Empire Fairgrounds and Event Center Rules and Regulations. Manufacturers, suppliers, distributors, or salespersons of such entities, IMPORTANT Please Contact WorldWide Drilling Resource 850-547-0102 for instructions for registration. PRINT & ONLINE *$15 (*$23 USD for Foreign) ONLINE *$12 (*$12 USD for Foreign) PRINT *$12 (*$20 USD for Foreign)
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