Spring Meeting Registration Form

Center 3for Resource Recovery & Recycling CR Spring Meeting Registration Form

Fax or Email Registration Information by May 3rd to: (508) 831-5993

Last Name______First Name______

Email Address (to receive confirmation)______

Daytime Phone______Fax______

Company______

Street Address or PO Box______

City______State______

Zip______Country______

Faculty & Corporate Registration $100.00______Student Registration $20.00______Fee includes all meals, breaks, and meeting materials. American Express Mastercard Visa Discover

Card #______Exp. Date______

Cardholder Name (please print)______

Signature______

Cardholder Billing Address______

City______State______

Zip Code______Country______

______I will attend Tues. and Wed. including the reception and dinner. ______I will attend Tues. and Wed. but not the reception and dinner on Tuesday evening. ______I will attend only Tuesday’s meeting. ______I would like a box lunch “to go” on Wednesday, May 11th

Please list any other requests or food allergies here and we will try to accommodate your needs.______