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Send completed form to: The Nature Conservancy, Attn: Susi Richardson

27 State Street, Suite 4 Montpelier, Vermont 05602 A confirmation letter with directions will be sent upon receipt.

For more information: www.nature.org/vermont/weeds or 802-229-4425

Name (first, last): __________________________________________________________________________________

Address: _________________________________________________________________________________________

City: ___________________________________________________ State: __________ ZIP: ___________________

Home phone: ____________________________________ Work phone: _____________________________________

Cell phone: ___________________________ Email address: ______________________________________________

Employer/company name: __________________________________

Method of payment

To pay by check, make checks payable to “The Nature Conservancy” and send them to the address at the top of this form. To pay by credit card, please fill out the following information:

Select card type: � Visa � Master Card � Discover � American Express

Cardholder name: ____________________________________________________________________________________

Cardholder address (if different from above): ______________________________________________________________

Cardholder phone number (if different): __________________________________________________________________

Card number: ___________________________________________ Expiration date: ______________________________

Signature: __________________________________________________________________________________________

Preferences: Please list all participants below, including yourself and any other employees from your company. Include names, occupations, lunch preferences, training dates and the cost of each participant ($45 each). Please use the codes listed below the chart to indicate your preferences. Lunch is included with the $45 registration fee and includes a meat (M) or vegetarian (V) sandwich, chips, fruit, cookies and a cold drink. If more room is needed please use reverse side.

Participant names (please print neatly) Occupation

(A-F) Lunch Training

(1-2) Cost

($45 each) �� MM �� VV $

�� MM �� VV $

�� MM �� VV $

�� MM �� VV $

�� MM �� VV $

TToottaall ccoosstt:: ## ppaarrttiicciippaannttss xx $$4455 $

Occupation choices (A-F):

A. Forester B. Logger C. Conservation organization staff member D. Landscaper E. Landowner

F. Other (please explain)

Training choices (1-2):

1. Sept. 21, 2011: Thetford Community Center, Thetford, VT

2. Sept. 27, 2011: Putney School, Putney, VT

Or…SAVE THE DATE and attend a training next spring. Registration begins April 1, 2012.

•••• May 22, 2012: Old Gray Barn, Rupert, VT

•••• May 29, 2012: Hinesburg Town Hall, Hinesburg, VT