Field Geology Services Short Courses Registration Form Page

Note: You may fill out this form then either print it and mail it to P.O. Box 824 Portland, Maine 04104

OR simply click "Submit Form" at the bottom of this page to automatically email it to Field Geology Services.

Please provide the following contact information (* = Required):

First Name*

Last Name*

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

FAX

E-mail*

Please provide the following registration information:

Using Fluvial Geomorphology in Watershed Assessment and Stream Restoration

April 26-27, 2017 in Augusta, ME $650 X =

Field Trip on April 28 $325 X =

Note: Special Student Pricing � Call or Email for Details!
Subtotal

Discounts (Apply all 3 if possible)

Non-profits, government agencies or educators/students $25 X =

Groups of 2 or more $25 X =

Early Registration (prior to March 31, 2017 ) $25 X =

Sum of Discounts

Total (TopTotal minus Total Discounts)

Grand Total Amount Due

(207) 491-9541 jfield@field-geology.com

Field Geology Services Short Courses Registration Form Page

Field Geology Home Flood Hazard Studies GIS-Based Watershed Assessment Stream Restoration Project Monitoring

Other Needs Professional Short Courses

Copyright �2017 Field Geology Services and. All rights reserved.

First Name*
Last Name*
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail*