Attendee Registration Form
Name (as you would like it to appear on name tag) Company Name Address City / State / Zip Phone / Fax Email
September 23-24 2009 Orlando, Florida
Please submit one registration form per attendee. Complete all sections of the registration form and return with payment to E-Scrap Conference, PO Box 42270, Portland, Oregon 97242-0270 or fax to 503.233.1356. Duplicate this form when registering more than one person from an organization. If payment is made for multiple attendees attach all individual registration forms to the check. For registration questions, contact Jef Drawbaugh at 503.233.1305 or jef@resource-recycling.com.
Title
Country
Check here if you require assistance, or special accommodations because of a disability, to make this program accessible to you. Someone from the conference office will contact you. Special request must be given to the conference office at least 10 working days prior to the conference. Check here if you would like a vegetarian meal for the luncheons. Check here if you would like a kosher meal for luncheons. Check here if you are a BrokerBin.com member and you’ll receive $35 off the registration fee. Check here if you are an ISRI member.
E-Scrap 2009 Registration Fee
Registration includes two continental breakfasts, two lunches, refreshment breaks, conference packet and admission to all E-Scrap 2009 sessions, tradeshow, and evening reception. Conference registration does not include lodging. All E-Scrap Conference sessions will be held at the Hilton Orlando. Onsite registration is subject to a $100 processing fee in addition to the late registration fee of $440. Registration fee is per person. Received by September 1st $415 - One from your organization $400 each - Two or more from your organization Received after September 1st $440 - One from your organization $425 each - Two or more from your organization
Payment
Total Due$
Full payment must accompany this registration application. Your confirmation and receipt will be emailed to the email address provided above. If you do not receive an email within 48 hours, please resubmit your registration form. Check (payable to Resource Recycling) Credit Card (check one): Visa MC
Additional Educational Opportunities
The following workshops will be held on September 22nd in conjunction with the E-Scrap Conference. For additional information, visit www.e-scrapconference.com. Received by September 1st Received after September 1st
AMX
Card Number Billing Address City / State / Zip Name on Card Signature
Exp Date
Certification in electronics Recycling - R2/RIOS 8:00 am - 12:00 pm $95 ISRI member/ $125 ISRI member/
$125 non-member $95 ISRI member/ $125 non-member $150 non-member
Country
1:00 pm - 5:00 pm
$125 ISRI member/ $150 non-member
Optimizing Profits in Electronics Recycling - R2/RIOS 8:00 am - 12:00 pm $95 ISRI member/ $125 ISRI member/
$125 non-member $95 ISRI member/ $125 non-member $150 non-member
1:00 pm - 5:00 pm
$125 ISRI member/ $150 non-member
Office Use Only:
JDDB CBDB Payment Badge Additional Activities:
Performance Measures for Electronics Recycling Programs: How Can we Measure Effectiveness? 1:00 pm - 4:00 pm $100 $125 e-Stewards Certification 2:00 pm - 5:00 pm
Free
Free