Field Geology Services Short Courses Registration Form Page

Note: You may fill out this form then either print it and mail it to P.O. Box 985 Farmington, Maine 04938 OR simply click "Submit Form" at the bottom of this page to automatically email it to Field Geology Services.

Please provide the following contact information (* = Required):

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Address (cont.)

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Please provide the following registration information:

Using Fluvial Geomorphology in Watershed Assessment and Stream Restoration

Course/Dates/Location Amount # of People Total

May 28-29, 2008 in Lebanon, NH / White River Junction, VT $345 X =

Field Trip on May 30 $175 X =

Subtotal

Discounts (Apply both if possible)

Non-profits, government agencies or educators/students $25 X =

Groups of 2 or more $25 X =

Early Registration (prior to April 30, 2008) $25 X

Sum of Discounts

Total Due (Subtotal minus Total Discounts)

BILLING

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Field Geology Services Short Courses Registration Form Page

Field Geology Home Flood Hazard Studies GIS-Based Watershed Assessment Stream Restoration Project Monitoring

Other Needs Professional Short Courses

Copyright ©2008 Field Geology Services and route2.com . All rights reserved.

First Name*
Last Name*
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail*

Course/Dates/Location	Amount		# of People		Total

May 28-29, 2008 in Lebanon, NH / White River Junction, VT	$345	X		=
Field Trip on May 30	$175	X		=

Subtotal
Discounts (Apply both if possible)
Non-profits, government agencies or educators/students	$25	X		=
Groups of 2 or more	$25	X		=
Early Registration (prior to April 30, 2008)	$25	X
Sum of Discounts
Total Due (Subtotal minus Total Discounts)