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.

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

First Name*

Last Name*

Title

Organization

Street Address NOTICE:

Address (cont.) THIS FORM IS CURRENTLY INACTIVE

City

State/Province

Zip/Postal Code

Work Phone

FAX

E-mail*

Please provide the following registration information:

Field Tour and Critical Analysis of Stream Restoration Projects in Western Maine

Courses/Dates/Locations

Amount

# of People

Total

May 18-20, 2009 in Newry/Bethel, Maine	$520	X	=

Discounts (Apply all 4 if possible)
Non-profits, government agencies or educators/students	$25	X	=
Groups of 2 or more	$25	X	=
Registering for both courses	$25	X	=
Early Registration (prior to April 17, 2009)	$25	X	=
Sum of Discounts
Total (TopTotal minus Total Discounts)

Using Fluvial Geomorphology in Watershed Assessment and Stream Restoration

May 27-28, 2009 in Lebanon, NH / White River Junction, VT $345 X =

Field Trip on May 29 $175 X =

Subtotal

Discounts (Apply all 4 if possible)

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

Groups of 2 or more $25 X =

Registering for both courses $25 X =

Early Registration (prior to April 17, 2009) $25 X =

Sum of Discounts

Total (Subtotal minus Total Discounts)

Grand Total Amount Due (combine total for both courses if applicable)

BILLING

Purchase Order #

Account Name

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 ©2009 Field Geology Services and route2.com . All rights reserved.

First Name*
Last Name*
Title
Organization
Street Address	NOTICE:
Address (cont.)	THIS FORM IS CURRENTLY INACTIVE
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail*


May 27-28, 2009 in Lebanon, NH / White River Junction, VT	$345	X	=
Field Trip on May 29	$175	X	=

Subtotal
Discounts (Apply all 4 if possible)
Non-profits, government agencies or educators/students	$25	X	=
Groups of 2 or more	$25	X	=
Registering for both courses	$25	X	=
Early Registration (prior to April 17, 2009)	$25	X	=
Sum of Discounts
Total (Subtotal minus Total Discounts)

Grand Total Amount Due (combine total for both courses if applicable)