2019 WITH CC Lead Poisoning Prevention and Healthy

2019 Lead Poisoning Prevention and Healthy Housing Conference

Secure Registration Form

Credit Card Required

* Most fields are required

Full name	*
First name (as preferred for badge)	*
Title	*
Company/Organization	*
Address (where credit card is authorized)	*
City	*
State	*
Zip	*
Phone	*
Fax
Email	*
Number of attendees	*

Registration Rates
For those registering between now and December 31, 2018: For 1 person from an organization, $185 For 2 or 3 persons from an organization, $170 per person For 4 or more persons from an organization, $155 per person For those registering between January 1 and January 31, 2019: For 1 person from an organization, $185 For 2 or 3 persons from an organization, $170 per person For 4 or more persons from an organization, $155 per person For those registering after February 1, 2019: For 1 person from an organization, $200 For 2 or 3 persons from an organization, $185 per person For 4 or more from an organization, $170 per person

Payment Amount (to be charged)	*
Credit card number	*
Card Code (CCV) - Typically on back of card	*
Exp Month (Numeric) example 01 = January	*
Exp Year (Numeric) example 2013	*
Name on card	*
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”.