Louisiana Solid Waste Association

Attendee Registration Form

Step 1 of 2:

Name:

Email Address:

Company Name:

Address:

LSWA currently accept all major credit cards
through PayPal.

PayPal

City: State: Zip:

Phone: Fax:

Fees:

225.00 Attendee Registration Fee (225.00 if paid by April 5, 2012)
250.00 After April 5, 2012 and On-Site Fee

75.00 Louisiana State Employee Registration Fee

40.00 Student Registration Fee (Must have current Student Identification)

Purchase Order Number:

Pleae read the following statement

REGISTRATION FEE IS NON-REFUNDABLE. SUBSTITUTIONS OF INDIVIDUALS MAY BE MADE PRIOR TO THE START OF THE CONFERENCE.

Note: If you receive no confirmation email or your card is not charged you have not been registered for the event. In this case please print out this form and fax it to Connie Henry at 985-878-2361.

I agree for the above statement