Register on line by completing the form below and
clicking the submit button. Once you submit your
registration form on line, you will be given the option of
going directly to the payment form or returning at a future
date to make your payment. You may pay either by
credit card or check/purchase order.
The registration fee is $145. If you are a speaker and
only attending the day of your session, no payment is due.
Your registration fee must be paid prior to the
conference. Remember that hotel registration is
separate.
Direct registration questions to
Joan B. Rogers, EPA Asbestos & Small Business Ombudsman,
202-564-6568,
rogers.joanb@epa.gov
or Angela Suber, EPA Asbestos & Small Business Ombudsman Team,
202-566-2827,
suber.angela@epa.gov.
Direct registration payment
questions to Francie Boker, 301-840-2222, x167,
fboker@prizim-inc.com.
Direct questions or problems with the registration form to Audrey
Graylin Zelanko: 724/452-4722,
zelanko@smallbiz-enviroweb.org.
Affiliation
Please choose which best describes your affiliation with the conference.
Other describe:
How long have you been with this program (years)?
Please choose your EPA Region.
Participant Requirements
Please tell us a little about yourself. Please indicate the appropriate responses.
I have special dietary needs. Please describe your special requirements.
Yes
Please describe:
I require visual, audio, or mobility assistance. Please describe your requirements.
Yes
Please describe:
Have you previously attended this conference?
Yes
No
Are you bringing resources for the information exchange?
Yes
No
Will you be a speaker/presenter/moderator?
Yes
No
Will you have a spouse/guest also in attendance?
Yes
No
Spouse/Guest Name
Do you need a parking space?
Yes
No
Please provide any additional comments or information:
For questions about the 2012 Annual 507
Program Training, contact:
Joan Rogers
rogers.joanb@epa.gov 202-564-6568
Angela Suber
suber.angela@epa.gov 202-566-2827
For questions about the conference web site, contact:
Audrey Graylin Zelanko
zelanko@smallbiz-enviroweb.org 724-452-4722