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Registration


Go to agenda for detailed information about conference sessions

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.

If you have already registered and need to pay, do NOT register again below.  Go directly to pay by credit card or pay by check/money 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.

 
Participant Information
First Name Middle Initial Last Name
Agency/Company Name
Mailing Address
City State Zip Code
Work Phone Fax E-Mail Address

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 202-564-6568
Angela Suber 202-566-2827
For questions about the conference web site, contact: 
Audrey Graylin Zelanko 724-452-4722