Mail or Fax Registration Form


	To register for the El Niño Workshop, please print out this page and mail or fax it to us. Make checks payable to College of Exploration El Niño Workshop El Niño Workshop, College of Exploration 2000 North 15th Street, suite 103, Arlington, VA 22201 USA Phone: 703 243 6622, Fax: 703-841-9798

I want to participate in the El Niño Workshop. My contact and payment information are detailed below:

Name and Mailing Address:


	Name (required):

	Title or position:

	Organization:

	Street address (or P.O. Box Number):

	City:

	State or Province:

	Zip or postal code:

	Country:

	Voice phone (required):

	Fax phone:

	E-mail address (required):


	Method of payment (check one):

1. Charge my fees to my credit card, or


2. Invoice my organization for my fees, or


3. Check or money order enclosed (in US dollars only).


	Credit Card information:

Visa,

or MasterCard,

or American

Express


	Billing Address: (if your organization will pay your fees)


	Purchase order number, if applicable:

	Name of person handling your accounts payable:

	Organization:

	Street address or PO Box number:

	City:

	State, Zip code: