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
Address (cont.)
City
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Please provide the following registration information:

Using Fluvial Geomorphology in Watershed Assessment and Stream Restoration

Courses/Dates/Locations Amount # of People Total
May 19-20, 2010 in Lebanon, NH / White River Junction, VT $395X =
Field Trip on May 21 $195 X =
        

Subtotal

Discounts (Apply all 4 if possible)
Non-profits, government agencies or educators/students $25X =
Groups of 2 or more$25X =
Registering for both courses$25 X =
Early Registration (prior to April 23, 2010) $25X =

Sum of Discounts

Total  (Subtotal minus Total Discounts)

          

Field Tour of Stream Restoration Projects in Western Maine

May 24-25, 2010 in Newry/Bethel, Maine $395X =
        
Discounts (Apply all 4 if possible)
Non-profits, government agencies or educators/students $25X =
Groups of 2 or more$25X =
Registering for both courses$25 X =
Early Registration (prior to April 23, 2010) $25X =

Sum of Discounts

Total (TopTotal minus Total Discounts)

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

BILLING
Purchase Order #
Account Name

Submisssion has been temporarily disabled. Please use alternate contact method.

 


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