2010 National Conference (New Orleans)
Secure Registration Form
Credit Card Required
Full name
*
First name (as preferred for badge)
Title
Company/Organization
Address (where credit card is authorized)
*
City
State
Zip
Phone
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Fax
Email
*
Number of attendees
Pre-Conference Workshop Sign Up
Workshop (add $50 Unless you are a member of the Grantee Association OR LEHA)
Technical Aspects of Grant Implementation from Intake to Closeout ($50)
Lead Inspection, Risk Assessment and Low-Cost Remediation Protocols ($50)
Healthy Housing Environmental Assessment and Hazard Remediation Protocols ($50)
Workshop on Child Lead Screening Strategies ($50)
Early Bird Rates (Good until December 31, 2009)
For 1 person: $395 / $365*
For 2 persons from the same organization: $375 / $345* per person
For 3 persons from the same organization: $345 / $315* per person
For 4 or more persons from the same organization: $315 / $285* 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 Industrial Hygiene Association
American Indoor Air Quality Council
Indoor Air Quality Association
American Public Health Association
United Parents Against Lead
Children’s Environmental Health Network
National Environmental Health Association
International Institute for Bau-Biology & Ecology (IBE)
Payment Amount (to be charged)
*
Credit card number
*
Card Code (CCV) - Typically on back of card
*
Exp Month (Numeric) ex. 01 = January
*
Exp Year (Numeric) ex. 2009
*
Name on card
*
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”.