2003 Gas Well De-Watering WorkshopPage 1

2011 Appalachian Basin Gas Well Deliquification Seminar

Seminar Registration Form

June 13 - 14, 2011

Please complete this form to register for the Appalachian Basin Gas Well Deliquification Seminar.

Please do not write or type in the shaded spaces.

Note: This form can only be used for remote, on-line registration until noon, Friday, May 20, 2011. After that time you can still register on-site, starting on Sunday, June 12, 2011.

Registration Information
Date of Your Application
Name
Company
Mailing Address
City/State/Zip Code
Country
Telephone Number
E-Mail Address
Dietary Needs: (Choose One) / Normal Vegetarian No Pork Low Carb Other ______
*To qualify for the Student rate, one must be enrolled full time as a student at a University or College
Badges
To assist the Seminar Committee and all attendees, all participants will be required to wear a badge at all times while at the Workshop. Badges will be color coded to indicate level(s) of registration: e.g. Continuing Education and/orTechnical Seminar. Special rates are available for students and people who will be attending Exhibit Booths only.
Continuing Education Courses
Allcourses are eight hours long. They will be on Monday, 8:00 - 5:00 pm. Cost is$300if register on or before May 20, 2011; $350after May 20, 2011.
Please √ the Course you’re registering for:
___ Course 101: Overview of Gas Well Deliquification
___ Course 102: Plunger Lift Course
___ Course 103/104: Sucker Rod Lift, Chemical for Deliquification
___ Course 105: Gas-Lift, Continuous Gas Circulation
Enter the amount for the course you are taking. / $
*Student rate to takeacourse is $150 on or before May 20, 2011; $200 after May 20, 2011. / $
Breakout Session – Field Trip
Please let us know if you’d like to take the field trip on Monday afternoon to a Range Resources Well Pad site. There is no cost, but you should bring a hard had and steel-toed shoes if you have them.
Workshop and Exhibit Registration
7th Annual Gas Well Deliquification Workshop
Enter the amount here if you wish to attend the Appalachian Basin Gas Well Deliquification Seminar and Exhibits.
Cost is $300if you register on or before May 20, 2011; $350 after May 20, 2011.
If you wish to attend the Exhibits only, and not the Technical Sessions, the cost is $150 per day for each day that you attend (registration at door only for this option). / $
*Student Rate to attend Workshop is$150if register on or before May 20, 2011; $200 after May 20, 2011. / $
A CD will be mailed to each participant after the Workshop. There is no additional cost for this. / $0.00
Enter total amount for attending the Workshop and Exhibits. / $
Total Payment Calculation
Enter the total you are paying for Continuing Education plus the Workshop & Exhibits. / $
Payment Options
To pay by check or money order, sendit to address below.
To pay be credit card: (American Express, Visa, or Master Card)
Credit Card Type:
Credit Card Number:
Expiration Date:
Billing Zip Code:
Name on card:

Return completed forms with payment to Ronda Brewer, Box 43111, Lubbock TX, 79409-3111 or or

fax to 806/742-3502. Make check payable to Southwestern Petroleum Short Course.