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1. Contact Information

Please enter your contact information below.

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* 1. First Name

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* 2. Last Name

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* 3. Organization/Affiliation

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* 4. Job Title

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* 5. City

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* 6. State

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* 7. Email address (required for registration confirmation)

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* 8. Please re-enter your email

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* 9. Work Phone (XXX) XXX-XXXX

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* 10. Do we have your permission to publish your work contact information, so we can provide participants with an electronic list of everyone in attendance?

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* 11. I grant the partner organizations (Georgia Department of Natural Resources, University of Georgia Marine Extension, Georgia Sea Grant, or Georgia Department of Community Affairs) its representatives and employees the right to take photographs of me and my property in connection with Successful Watershed Planning- How to Develop and Fund a Watershed Management Plan workshop.  I authorize the partner organizations, its assigns and transferees to copyright, use and publish the same in print and/or electronically.  I agree that the partner organizations may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

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