SEMINAR REGISTRATION FORM
January 24, 25, & 26, 2006

	January 24 or 26	January 25	January 24, 25, & 26
Preregistration	$60/day (lunch included)	$70(lunch included)	$165(lunch included)
Registration at the Door (as space permits)	$70/day (lunch included)	$85(lunch included)

 

* lunch included all days
** If NVCC closes due to inclement weather, that seminar day will be rescheduled.

SPACE IS LIMITED, SO REGISTER EARLY. SORRY, NO REFUNDS

To preregister complete and mail this form and payment prior to January 16, 2006 to:
Green Industry Professional Seminar
P.O. Box 59
Fairfax Station, VA 22039

Make check payable to "Green Industry Professional Seminar"
GOVERNMENT VOUCHERS WILL NOT BE ACCEPTED

Please Print Clearly or Type

NAME OF EMPLOYER: _________________________________________________________________________

ADDRESS: __________________________________________________________________________________

PHONE: ______________________________ CONTACT PERSON: ______________________________________

E-MAIL ADDRESS:____________________________________________________________________________

NAME OF PERSON(S) AND DATE(S) FOR HISPANIC SESSION:

__________________________________________ ________________________________________________

__________________________________________ ________________________________________________

Total number registering for Jan. 24, 25, & 26 _____________ x $165 = ______________________________

Total number registering for Jan 24 _____________________ x$60 = ________________________________

Total number registering for Jan 25 _____________________ x$70 = ________________________________

Total number registering for Jan 26 _____________________ x$60 = ________________________________