The North Carolina Division of Coastal Management,

North Carolina Coastal Nonpoint Source Program,

And North Carolina National Estuarine Research Reserve

Present:

 Clean Marina Workshops

Fax Registration Form

252-728-6273

Registrations must be received a week before the workshop.

Please check which workshop you are attending:

____ January 18, 2005: New Bern

 ____ January 20, 2005: Wilmington

 ____ February 1, 2005: Manteo

Your Name:__________________________________________

Marina’s Name:_______________________________________

Job Title:____________________________________________

Fax Number:_________________________________________

Phone Number:_______________________________________

Email Address:________________________________________

Would You Like a Vegetarian Lunch?    ____ Yes    ____ No

Confirmation of registration will be sent via email (if applicable) or fax.

Co-Sponsored by: SBTDC Marine Trades Services