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					              ENVIRONMENTAL HEALTH DIRECTORS’ MEETING
                        OCTOBER 19-21, 2011
                    ENZIAN INN, LEAVENWORTH, WA
                         REGISTRATION FORM

Name


Representing


Address




Phone Number                                         FAX Number


E-mail Address

If staying at the Enzian, reference the following:

             Name: Environmental Health Directors
              Group #8649
             Reservation Phone: (800) 223-8511
             Rooms will be held until September 19, 2010

□ Please check if attending Wednesday afternoon

Send completed registration form and a $60 check payable to:

       WSEHD
       Attn: Faith Taylor-Eldred
       PO Box 68
       South Bend, WA 98586
       (360) 875-9356
       FAX (360) 875-9304

                Please have registration in by September 23, 2011.
                             THIS FORM IS YOUR INVOICE.
              SORRY, CANNOT ACCEPT PURCHASE ORDERS OR CREDIT CARDS.

				
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