BLUEGRASS ENGINEERING & SURVEYING, INC.        REGISTRATION/ORDER FORM Name____________________________Address__________________________________ City___________________________State_________________Zip Code_______________  Email Address______________________________________________________________ Home/Cell Phone________________________Bus. Phone___________________________                      PLS#_____________State _________         PLS#_____________State _______________ PE# ______________State_________             LA#______________State _______________ Course(s) in PDF ______Course(s) on CD-ROM_______Seminar Date__________________ PDF Orders are emailed within 24 hours of receiving course order with payment.  CD-ROM orders are sent by first class mail within 2 business days of receiving order with payment. Courses (Please list)___________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________   Amount enclosed $___________ Print out and complete this form, and mail with your check to: Bluegrass Engineering & Surveying, Inc. 3504 Nakomis Ct. Lexington, Kentucky 40517-3821