Registration

*Required Information

*First Name
Name Preferred If Different From Above
*Last Name
Birthdate: month/day(05/17)see note below
Job Title
Firm/Organization
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
Country
*Work Phone
*Above address is Work or Home? (Indicate)
FAX
*E-mail

Note: Birthdate (month and day only) is used as an identifier to distinguish between two people with the same name.

 

 

 

Fee $545

State of NC Employees and NC Local Govt. $400

(Exhibit space full)

Post-conference Workshops (Choose 1)

Green Roof Design Workshop, Mar 14 (no additional fee)

LID Design Workshop, Mar 14 (no additional fee)

FULL Coastal LID Tour, Mar 14 (no additional fee)

Lockwood Folly Tour, Mar 14 (no additional fee)

 

 

*Method of payment:

Visa or MasterCard (please call 919-515-7154 with card information) 

I will mail in check, including a copy of this completed form 

Please invoice my company

Purchase Order No.

Make check(s) payable to:
North Carolina State University

Mail to:
Kathryn Murray
NCSU Soil Science Department
Campus Box 7643 - UFL
Raleigh, NC 27695-7643

Total Registration Fee:

Additional Comments: Add any comments or special needs here.