SBO/SBEAP National Conference
June 1-5, 2009 Louisville, Kentucky
Winning the Race for Environmental Excellence
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Register

Go to agenda for detailed information about conference sessions
Submit registration on line below (preferred) or print out and mail/fax the form to Audrey Zelanko below.  You may pay either by credit card or check/purchase order.  Once you submit your registration form on line, a payment form will direct you to pay by credit card on line or print out a form and mail with payment by check or money order.  Please note registration fees below.  Registration will be closed _______________.  Remember that hotel registration is separate. 

Registration fees are as follows: ___________________________________.

Mail or fax this registration form (if not registering on line) to:
Audrey Zelanko
Small Business Environmental Home Page
221 Meadowbrook Drive
Cranberry Township, PA  16066
Fax 724/452-5840

If you are printing out this registration form to submit by mail or fax, go directly to the credit card payment form or check/purchase order payment form to submit payment.

Direct registration questions to Kenya Stump.    
Direct questions or problems with online form to Audrey 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
I would like to receive email updates on the 2009 SBO/SBEAP National Conference     Yes     No

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:

Conference Registration
Please select the days and events you will be attending.

Monday, June 1, 2009
    Yes     No    Optional Activity; go to After Hours Activities web page for more information)
    Number of guests attending (do not include yourself)

Tuesday, June 2, 2009
    Yes     No    9:00AM - 10:00AM  
    Yes     No   11:30AM - 1:00PM
    Yes     No    1:00PM - 4:30PM 
    Yes     No    4:45PM - 5:45PM  
    Yes     No    6:00PM - 8:00PM

Wednesday June 3, 2009
    Yes     No    8:00AM - 8:45AM  
    Yes     No    9:00AM - 12:00PM  
    Yes     No    12:00PM - 1:50PM
      2:00PM - 3:30PM Breakout 
      2:00PM - 3:30PM Breakout
      2:00PM - 3:30PM Breakout 
      2:00PM - 3:30PM Breakout -- Not able to attend
      3:45PM - 5:15PM Breakout 
      3:45PM - 5:15PM Breakout
      3:45PM - 5:15PM Breakout
      3:45PM - 5:15PM Breakout -- Not able to attend
    Yes     No     6:30PM Optional Trip; go to After Hours Activities web page for more information)
    Number of guests attending (do not include yourself)
 
Thursday, June 4, 2009
    Yes     No    7:45AM - 8:45AM 
    Yes     No    7:45AM - 8:45AM 
    Yes     No    9:00AM - 12:30PM 
    Yes     No 12:30PM - 2:00PM )
   2:00PM - 3:30PM Breakout
   2:00PM - 3:30PM Breakout
   2:00PM - 3:30PM Breakout -- Not able to attend
   3:45PM - 5:15PM Breakout
   3:45PM - 5:15PM Breakout 
   3:45PM - 5:15PM Breakout -- Not able to attend

Friday, June 5, 2009
    Yes     No    7:45AM - 8:45AM 
    Yes     No    7:45AM - 8:45AM
    Yes     No    7:45AM - 8:45AM
    Yes     No     9:00AM - 11:30AM

 
 
Questions - contact Kenya K. Stump at
Kentucky Division of Compliance Assistance
Environmental Compliance Assistance Program
300 Fair Oaks Lane
Frankfort, KY 40601
Phone: 502-564-0323 ext 134 - Fax: 502-564-9720
kenya.stump@ky.gov
 www.dca.ky.gov

For questions or comments about the web site, contact Audrey G. Zelanko
Go to Small Business Environmental Home Page