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Registration Form
For multiple registrations, please make additional copies of this form and complete separately.
Name:_______________________________________________________________________________
Title: ________________________________________________________________________________
Organization:_________________________________________________________________________
Address:_____________________________________________________________________________
City: __________________________________________ State: _______ Zip:_____________________
Telephone: __________________ Fax: ________________ Email: ________________________
I am: _____ SWANA Member - $250 _____ ADPH/ADEM Staff - $250
_____ ARC Member - $250 _____ Non-Member - $350
I am: _____ Exhibitor - $600 _____ Landfill operator Course only - $45
(Exhibitor includes 2 people per booth) (Includes Tuesday Lunch & Tradeshow)
Additional exhibitor representatives: Name(#2):_________________________________________________________________________
Extra Exhibitor Representative@$100___________________________________________________
Spouse - $50 (includes all meal functions)
Name:___________________________________________________________________________
Activities
_____ Golf Outing - $60 per player (includes greens fees, cart and lunch)
Name: __________________________________ Hdc: ______
Name: __________________________________ Hdc: ______
Sponsorships
_____ Dinner - $1,000 _____ Reception - $500
_____ Golf - $500 _____ Continental Breakfasts - $350
_____ Refreshment Break - $250
Total Enclosed: $ ___________
Please circle one: Visa MasterCard American Express
Credit Card #: ____________________________Expiration Date: ______Billing Zip Code:_______
Signature:_________________________________________
Please send your form to the SWANA Alabama Chapter:
Mail: Post Office Box 240757
Montgomery, AL 36124-0757
Fax: (334) 272-7128
Phone:(334) 260-7970
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