Registration Form

Seminar on Safety Evaluation of Existing Dams
July 14-18, 2014

Please complete and submit this form by June 9, 2014
(If you are a Department of Interior (DOI) Employee, registration and
supervisor approval in DOILearn is required.)


Name:  _________________________________________________________________________

Position or Title:  ____________________________________________________________
(Note: Attendance is limited to Federal, Tribal and Water Districts 
affliated with Reclamation Projects only.  If you are with a District, 
please indicate the Reclamation Area Office you primarily work with)

Telephone:  ____________________________________________________________________

Mailing Address:  ______________________________________________________________

City, State, Zip Code:  ________________________________________________________

E-mail address (optional):  ____________________________________________________

Please indicate which one of the concurrent workshops you will attend:

________  Engineering Geology and Dam Safety

________  Evaluation of Seepage, Uplift, and Piping Concerns

________  Emergency Management Tabletop Exercise

Please indicate (circle) if you plan to attend the field trip planned for
Wednesday 7/16/14:  Yes  /  No

Mail the completed form to:					Or fax to:
          Bureau of Reclamation				Lisa Krest
          ATTN: Lisa Krest						303-445-6473
          P.O. Box 25007
          Mail Code 85-831300					or E-mail
          Denver, CO  80225