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I want to participate in the El Niño Workshop. My contact and payment information are detailed below: Name and Mailing Address: |
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Name (required): |
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Title or position: |
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Organization: |
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Street address (or P.O. Box Number): |
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City: |
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State or Province: |
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Zip or postal code: |
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Country: |
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Voice phone (required): |
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Fax phone: |
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E-mail address (required): |
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1. Charge my fees to my credit card, or |
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2. Invoice my organization for my fees, or |
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Purchase order number, if applicable: |
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Name of person handling your accounts payable: |
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Organization: |
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Street address or PO Box number: |
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City: |
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State, Zip code: |
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