EBIPM Field School Registration Form

Name: _____________________________________________

Business or Organization:______________________________

Mailing Address: _____________________________________

City: _______________________________________________

State:__________________ Zip: _________________________

Phone: _____________________________________________

Cell Phone: __________________________________________

FAX: _______________________________________________

Email Address: _______________________________________

Note: Upon receipt of registration we will email you a workshop packet with reading and materials to prepare prior to attendance.

Will you be camping at the Circle Bar? yes____ no____

Which nights?

Tues. Sept. 15 ___ Wed. Sept. 16____ Thurs. Sept. 17___

Which meals should we reserve for you?

Lunch on Wed._____

BBQ Dinner on Wed. ______

Lunch on Thurs.______

Pending: Credits for SRM Rangeland Professional have been applied for as well as continuing education credits for pesticide applicators for Oregon and Washington Dept. of Agriculture.

Will you be applying for any of these credits? yes______no______

Registrations must be received by September 7, 2009

Mail this form to: Brenda Smith, Eastern Oregon Agricultural Research Center (EOARC), 67826-A Hwy 205 Burns, OR 97720

OR

FAX this form to: Brenda Smith, 541 573-3042

OR

Email this form to: brenda.smith@ars.usda.gov