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2012 MOHAWK WATERSHED SYMPOSIUM
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
eMail address
*
Your answer
Contact Phone Number
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Position
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Organization
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Address 1
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Address 2
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City
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State
Choose
NY
MA
PA
VT
Ontario, Canada
Zip Code
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Register as:
*
Registration deadline: February 22, 2012
Registration $25.00
Student Registration $10.00
Late Registration (after Feb. 22, 2012) $30.00
Late Student Registration (after Feb. 22, 2012) $15
Other:
Required
Banquet Registration
*
Evening dinner at College Park, pre-payment required.
Chicken Dinner: $25.00
Vegetarian Dinner: $25.00
Will not attend Banquet
Required
Do you anticipate presenting?
*
Yes
No
Required
If presenting, will you Talk or present a Poster?
Talk
Poster
Presentation Title
Please provide us with title of talk of poster
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