Workshop Registration

Registration:
Please fill in all of the fields that pertain to you. Thank-you!
Note: All information submitted is completely confidential and secure.
We will not release any personal information except under your direct approval.
* = Required Information

Your Information:

Title:

First Name:

Last Name:

Mailing:

Mailing 2:

City:

State:

Zip:

Country:

Email:

Phone:

Extension:

Fax:

JobTitle:

Organization:

Sponsor:

Affiliation:

Type of Work:

Website:

About you:

Workshop Selection:

Workshop Date:	Alternate Workshop Date:
How will you make payment: Payments need to be mailed, no credit cards are accepted.	Do you wish to seek PREP Funding: (Check for YES)
The Piscatqua Region Estuaries Partnership will cover fees for Planning Board and Conservation Commission Members for the 42 Coastal Watershed communities.
How did you hear about the workshops?

Contact Information:

Maddy Wasiewski
Environmental Research Group
University of New Hampshire
214 Gregg Hall, 35 Colovos Road
Durham, NH 03824
Phone: 603-862-2206
Fax: 603-862-3957
EMAIL: Maddy Wasiewski

You will receive a confirmation email when our staff has completed processing your registration.