Environmental Action 2010
Sunday, April 11, 2010

Bentley University, Waltham, MA

10:00 am- 5:30 pm
Mobilizing the Grassroots for a Greener New England


Individual Registration Page

If you want to register as a cosponsor, click here.

Contact Information:

Name:

Address:
 
City:
State:
Zip:
Phone:
E-mail:
Group Name:

Want to mail in your registration form? Click here to download a printable version!

   
Who did you hear about the conference from?
Payment Worksheet:
   

Individual Registration ($30)

Non-Bentley Student Registration ($15)

Bentley Student or Faculty (Free)

 

If you are registering more than one attendee, please complete this form and payment, then return to this page for additional attendees.

Lunch: In addition to the complimentary breakfast and afternoon reception, we will be serving Boloco Burritos for lunch, which can be purchased for $5. To ensure we order enough, please indicate what tyle you would prefer if you are ordering lunch.

Veggie    Chicken Beef

 

Insert Total Payment Here (registration + $5 lunch if ordered)

Additional Information:

 Need childcare? Note: You must pre-register childcare so we can plan accordingly.
Yes / No
Number of children?
Ages?



 

  x

Payment Method:
Check     Credit Card

To pay by check:Select "Check,"click "Register," then mail your check to Toxics Action Center, 44 Winter St, 4th Floor, Boston, MA 02108. Please make the check payable to Toxics Action Center and write "Environmental Action 2010" in the memo line.

To pay by credit card: Select " Credit Card," click "Register" and enter your payment information on the next page. If you have any questions, please e-mail sam@toxicsaction.org or call (617) 747- 4362.