Name*:

Company*:

Address *
(must be street address, no P.O. Boxes):

City/State/Zip*:

E-mail*:

Phone*:

APICS Member*?:

Yes ($760.00)

No   ($1,075.00)

APICS Member Number*:

Payment Method*:

Check (Payable to APICS North Shore Chapter)
(Print Order Form below to include with payment)

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Mail payment to: Art Harvey, 55 Crystal Ave, #255, Derry, NH 03038