Customer Registration Form

* indicates required fields

*Company Name
*Company Street
Company Street 2
*Company City
*Company State
*Company Zip
*Contact Name
*Contact's Email
*Contact's Phone	numbers only. No spaces, dashes, or ()
Contact's Fax
Class Name:	Laboratory Ventilation Management $249.00 Biological Safety Cabinet (NSF-49) $249.00 Pharmaceutical Regulated Cleanrooms and HEPA Filters $475 Laboratory Ventilation Management and Biological Safety Cabinets $475 Laboratory Ventilation Management and Pharmaceutical Regulated Cleanrooms and HEPA Filters $699 Biological Safety Cabinets and Pharmaceutical Regulated Cleanrooms and HEPA Filters $699 Laboratory Ventilation Management, Biological Safety Cabinets and Pharmaceutical Regulated Cleanrooms and HEPA Filters $849 Decontamination (ClO2 vs. Formaldehyde) By Request Cleanroom & HEPA Filter Testing (By Request)
Name of individuals(s) attending (include contact's name if attending)
*Name	*Email Address






Additional Comments/Instructions

Micro-Clean, Inc. reserves the right to cancel or postpone classes. In the event of a cancellation or postponement, we will provide a minimum of 2 days notice. In the event of a cancellation, registrants will receive a full refund if applicable.

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