Drive Electric Illinois - Forum Registration

Electric Vehicle Forum Registration Form

Thank you for your interest in the Drive Electric Illinois Electric Vehicle Forums. Attendance is free, but is limited to the first 60 registrants at each location. Each of the Forums are expected to be full day sessions lasting from approximately 9AM to 4PM and will include lunch. For forum location, hotel, and parking information, please visit www.DriveElectricIllinois.org.

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* 1. Name

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* 2. Phone Number:

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* 3. Email Address:

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* 4. Employer:

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* 5. Job Title:

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* 6. I would like to register for the following Drive Electric Illinois Electric Vehicle Forum(s):

American Lung Association in Illinois, Chicago Office - Chicago, IL - June 18, 2013

Harper College - Palatine, IL - June 5, 2013

Illinois Central College - Peoria, IL - October 19, 2012

University of Illinois - Champaign/Urbana, IL - October 23, 2012

Western Illinois University, QC Campus - Moline, IL - May 10, 2013

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* 1. Name

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* 2. Phone Number:

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* 3. Email Address:

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* 4. Employer:

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* 5. Job Title:

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* 6. I would like to register for the following Drive Electric Illinois Electric Vehicle Forum(s):

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* 7. I have the following dietary needs (please specify):