Registration Form

Seminar on Safety Evaluation of Existing Dams
May 23-27, 2011

Please complete and submit this form by May 13, 2011

Name:  _________________________________________________________________________


Position or Title:  ____________________________________________________________


Organization:  _________________________________________________________________


Telephone:  ____________________________________________________________________


Mailing Address:  ______________________________________________________________


City, State, Zip Code:  ________________________________________________________


email address (optional):  _____________________________________________________



Check one of the following:


________  I am enclosing training form SF-182 for billing my agency
          (Federal government employees only)


________  I will pay with Visa, Mastercard, or American Express


Name on Card, Card Number, Expiration Date: ____________________________________


________  I am enclosing my advance registration fee of $800.00


________  I will pay the $800.00 registration fee upon arrival


(Checks should be made payable to the Bureau of Reclamation.)




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

Mail the completed form to:					Or fax to:
          Bureau of Reclamation					Charlie Swanson
          P.O. Box 25007					303-445-6473
          Mail Code 86-68360
          Denver, CO  80225