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Environmental Action 2006 registration
Saturday, October 21, 2006 at Bowdoin College in Brunswick

This registration form registers three people. Additional members of groups should register individually.

Click here to see the agenda, list of workshops and other information about the conference.

Click here to see a list of conference co-sponsors.

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

Payment Work Sheet:

Conference Cosponsor (Statewide groups)
($40 for first two people, $15 for each additional person)
X $15= (Put this amt. in box on the right.)

If cosponsoring group, enter name and address of second attendee here:


If cosponsoring group, enter name and address of third attendee here:

$40
+
=

 
OR

Conference Cosponsor (local community groups)
($30 for first two people, $15 for each additional person)
X $15= (Put this amt. in box on the right.)

If cosponsoring group, enter name and address of second attendee here:


If cosponsoring group, enter name and address of third attendee here:

$30
+
=

 
OR
Individual Registration ($20/each)
X $20= (Put this amt. in box on the right.)
  x
Total amount due for conference registration.

Please select your payment method:
Check     Credit Card

If you've chosen to pay by check, click "register" and send your check, made out to Toxics Action Center, to 39 Exchange Street, Suite 301, Portland, ME 04101. If you've chosen to pay by credit card, click "register" and enter your payment information on the next page. If you have any questions, please e-mail or call (207) 871-1810.

 
 
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