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):

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

Please provide the following registration information:

Using Fluvial Geomorphology in Watershed Assessment and Stream Restoration

April 26-27, 2017 in Augusta, ME $650X =
Field Trip on April 28 $325X =
   Note: Special Student Pricing Call or Email for Details!  

Subtotal

 
Discounts (Apply all 3 if possible)
Non-profits, government agencies or educators/students $25X =
Groups of 2 or more$25X =
Early Registration (prior to March 31, 2017 ) $25X =

Sum of Discounts

Total (TopTotal minus Total Discounts)

Grand Total Amount Due

 


(207) 491-9541          jfield@field-geology.com


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