Application for Admission

First Name:

Last Name:

Middle Initital:

Company Name:

Plant Mailing Address:

City:

State / Province:

Zip Code:

Country:

Plant Phone Number:

Fax Number:

Email Address:

Request a Special Session or have a School Custom Designed for You Requirements:

Applicant's position and Brief Description of Job Responsiblies:

Approximate Length of Experience in Glass Container Industry:

Application is hereby made for Admission to (Check preferred type of training session)
(All seminars are to be held at American Glass Research, Butler Pennsylvania, unless otherwise indicated)

Effect of Design on Bottle Performance $1,200.00 USD per person 1.210 Euro (For Munich Session) September 12 - 13, 2012 October 22 - 23, 2012 Held in Munich , Germany	Batch & Furnace Operations $1,400.00 USD per person 1.560 Euros (for Munich Session) May 14-17, 2012 November 13- 16 2012 Held in Munich , Germany

Advanced Batch & Furnace Operations $1,400.00 USD per person May 8 -11, 2012	Testing & Fracture Diagnosis of Pharmaceutical Glassware $1,250.00 USD per person $1,300 Euros (for Munich Session) September 25-27, 2012

Cord and Annealing $1,250.00 USD per person November 6 - 8, 2012	Testing & Fracture Diagnosis of Glass Bottles $1,400.00 USD per person 1.410 Euros (for Munich Session) March 19 - 21, 2012 Held in Munich , Germany April 17 - 20, 2012 October 17-19, 2012 Held in Munich , Germany September 18 - 21, 2012
Coating Technology $1,200.00 USD per person 1.160 Euros (for Munich Session) October 15 - 16, 2012 Held in Munich , Germany April 25 - 26, 2012


Advanced Fracture Diagnosis of Field Performance Problems $1500.00 USD per person 1.530 Euros (for Munich Session) March 13 -16, 2012 Held in Munich , Germany December 4-7, 2012 Evaluation of Glass Container Manufacturing Plant Operations $1200.00 USD per person	Analysis of Stones $1250.00 USD per person October 9 - 11, 2012

For seminars held in the USA, please remit checks, purchase order numbers, etc., to:

American Glass Research
Attn: Linda Pilosi
603 Evans City Road
Butler PA 16001

If, due to a disability, you have any special needs, or have any question, Please let us know.

COMPANY AUTHORIZATION:
This application must be authorized by a company official, manager, or other person in a position of responsibility with respect to applicant and who will undertake to act as contact person with American Glass Research for receiving further instructions, reports of candidate's work, notification in case of emergencies, and completing business arrangements.

Company Approved By:

Title:

Date:

Please submit a P.O. number or check with this application form. However, if you would like to pay via a corporate credit card, please contact us. Any cancellations incurred less than two weeks prior to the seminar start date will be subjected to a cancellation fee, which is 50% of the designated seminar fee. Any “no-shows” will be subjected to full tuition payment.