Online Registration: Child Agricultural Injury Prevention Workshop
August 6-7, 2019
Lexington, Kentucky

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Name (First and Last): (Required.)

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Job Title:

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Organization Name: (Required.)

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Mailing Address: (Required.)

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City, State/Province, Country, Postal Code: (Required.)

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Phone (Daytime): (Required.)

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Phone (Cell or Other):

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Email Address: (Required.)

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Dietary Restrictions or Allergies:

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I will be attending the free pre-workshop reception on August 5 (evening): (Required.)

Yes

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Registration:
Note: Registration fees are due 30 days prior to the workshop. A reminder will be sent two weeks prior to the due date.

$199 Early Bird Registration

$249 Registration after July 15, 2019

Code:

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I will pay the registration fee by:

Check (make payable to Marshfield Clinic and mail to Marshfield Clinic; Conference Registration-GR; 1000 N Oak Ave; Marshfield WI 54449)

Credit Card, please call 715-389-3776 to make payment (Marshfield Clinic accepts MasterCard, VISA, American Express, Discover)

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AgInjuryNews.org

Register me (free of charge) for AgInjuryNews.org (This website will be used/referenced during the workshop. Website registration will be helpful, but is not required)

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Thank you for your registration. If you have any comments, please enter them below.

Click on the Submit Registration button to complete your registration.
*Please note: you will not receive a confirmation email immediately upon submitting your registration. An email confirmation will be sent within 1 week of registration.

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* Name (First and Last): (Required.)

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* Job Title:

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* Organization Name: (Required.)

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* Mailing Address: (Required.)

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* City, State/Province, Country, Postal Code: (Required.)

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* Phone (Daytime): (Required.)

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* Phone (Cell or Other):

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* Email Address: (Required.)

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* Dietary Restrictions or Allergies:

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* I will be attending the free pre-workshop reception on August 5 (evening): (Required.)

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* Registration: Note: Registration fees are due 30 days prior to the workshop. A reminder will be sent two weeks prior to the due date.

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* I will pay the registration fee by:

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* AgInjuryNews.org

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* Thank you for your registration. If you have any comments, please enter them below.

Name (First and Last): (Required.)

Job Title:

Organization Name: (Required.)

Mailing Address: (Required.)

City, State/Province, Country, Postal Code: (Required.)

Phone (Daytime): (Required.)

Phone (Cell or Other):

Email Address: (Required.)

Dietary Restrictions or Allergies:

I will be attending the free pre-workshop reception on August 5 (evening): (Required.)

Registration:
Note: Registration fees are due 30 days prior to the workshop. A reminder will be sent two weeks prior to the due date.

I will pay the registration fee by:

AgInjuryNews.org

Thank you for your registration. If you have any comments, please enter them below.