2011 National Conference
(Miami, Florida)
Secure Registration Form
Credit Card Required
* Most fields required
Full name
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First name (as preferred for badge)
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Title
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Company/Organization
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Address (where credit card is authorized)
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City
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State
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Zip
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Phone
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Fax
Email
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Number of attendees
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Pre-Conference Workshop Sign Up
Workshop (add $50 Unless you are a member of the Grantee Association OR LEHA)
Technical Assistance Workshop for Grantees on the Technical Aspects of Grant Implementation
from Intake to Closeout ($50)
Workshop on Child Lead Screening Strategies ($50)
Workshop on Healthy Homes Asssesment and Remediation Protocols ($50)
Workshop on Inspection and Clearance Protocols, and Low Cost Lead Hazard Control
and Abatement Methods ($50)
Registration Rates (Good until January 31, 2011)
For 1 person: $365 / $335*
For 2 persons from the same organization:: $345 per person / $315* per person
For 3 persons from the same organization: $315 per person / $285* per person
For 4 or more persons from the same organization: $285 per person / $255* per person
* This rate is for a person whose organization is a member of one of the following organizations:
- Lead and Environmental Hazards Association
- National Association of Lead and Healthy Homes Grantees
- American Public Health Association
- National Environmental Health Association
Payment Amount (to be charged)
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Credit card number
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Card Code (CCV) - Typically on back of card
*
Exp Month (Numeric) ex. 01 = January
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Exp Year (Numeric) ex. 2009
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Name on card
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Description of purchase
*
REGISTRATION CANCELLATION POLICY: Cancellations must be in writing. Refunds will be given to all requests received up to 72 hours before the first day of the conference, less a $45.00 cancellation fee. No refunds will be given for “no shows”.
