MAERS Workshop - $75

* Name 1 (first & last):	Email:
Name 2 (first & last):	Email:
Name 3 (first & last):	Email:
Name 4 (first & last):	Email:
Name 5 (first & last):	Email:
* Company Name:
* Mailing Address:
* City:
* State:
* Zip Code:
* Daytime Phone:
	Confirmations will be sent 1 week prior to the workshop to those providing an Email address listed above. Yes, please notify me via Email of future training (If you check this box, be sure and include your Email address in the box above.)
* I will attend (check one):	January 21, 2010 - Gaylord January 21, 2010 - Marquette Video Conference      January 26, 2010 - Livonia - CLOSED - session is full January 28, 2010 - Kalamazoo- BRING YOUR OWN LAPTOP      February 2, 2010 - Dearborn - CLOSED - session is full February 4, 2010 - Muskegon      February 9, 2010 - Livonia - CLOSED - session is full      February 11, 2010 - Lansing - CLOSED - session is full
Affiliation:	Industry Attorney Consultant Government Utility Other:
Company Size:	Less than 100 employees 100-500 employees Over 500 employees
Comments:
Cancellation Policy:  If you do not cancel by 5:00 p.m. four business days before the workshop, you are responsible for the registration fee.
* Payments:	I will pay by credit card. See secure credit card processing instructions on the confirmation page. I will send a check for the registration fee.  See mailing instructions on the confirmation page.