DERA 50th Anniversary Conference

DERA 50th Anniversary Celebration and Preparedness Workshop

Asheville, North Carolina

June 15-17, 2012

DERA 50th Anniversary Preparedness Workshop

Thank you for your interest in attending the DERA Preparedness Workshop and 50th Anniversary in Asheville, North Carolina, June 15-17, 2012.

There is no registration fee for current DERA members and members of our partnership organizations; however meals are not included.

Non-Members are welcome on a space-available basis and may register at http://www.disasters.org/dera/nonmember2012.htm

DERA Members and Partnership Organization Members are invited to register below.

If you wish to register by mail, please print this form, fill in information and mail to:

DERA Workshop

P.O. Box 797

Longmont, CO 80502 USA

Please provide the following registration information:

First Name *

Last Name *

Title

Organization *

Address 1 *

Address 2

City *

State /Province *

Postal Code *

Country, if not USA or Canada

Telephone *

Fax

Email Address *

May we share your contact information with other attendees? *

Yes

Indicate Sessions You Plan to Attend: *

Friday, June 15th - Morning Workshop

Friday, June 15th - Luncheon (Select from Menu & Pay for Own Meal)

Friday, June 15th - Afternoon Workshop

Friday, June 15th - Evening Reception (No-Host Bar Service)

Saturday, June 16th - Morning Workshop

Saturday, June 16th - Mount Mitchell Field Trip

Sunday, June 17th - Tours

Functional needs, access requirements or special accommodations you would like:

Are you a current DERA member or a member of a partnership organization? *

Current DERA Member

Expired DERA Member -- Please register me & send information on becoming current.

Not a member but conditionally reserve a space for me and send non-member registration information.

Member of a Partnership Organization (tell us which one in block below)

Name of Partnership Organization (if any):

Will you need transporation to the Mount Mitchell field exercise on Saturday, or can you provide a ride for others? *

I would like to ride with someone else

I can take 1 person in my vehicle

I can take 2 people in my vehicle

I can take 3 people in my vehicle

I can take 4 or more people in my vehicle

I am not attending the field exercise

I am undecided

Tell us anything else we need to know about your plans.

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P.O. Box 797

Longmont, CO 80502 USA