Thank you for registering to attend the:

Northwest Indiana Environmental Boot Camp for Local Officials
May 7 - 9
Northwestern Indiana Regional Planning Commission
6100 Southport
Portage, IN 46368

Registration Fee includes lunch and snacks throughout the workshop


Please provide the information requested below.

Items marked with an * are required.

* I would like to Register For:

* First Name:

* Last Name:

* Organization and Title

* Address Line 1:

* Address Line 2:

* City:

* Zip Code:

* Phone:

* E-mail:

* Please let us know if you might need any of the following services (Note the meeting venue is wheelchair accessible and ADA compliant):

* How did you hear about Environmental Boot Camp?
Select all that apply.

T