Lead-Safe_Indiana_Conf_2009

Photo courtesy John Winters

Thanks to The Boren Foundation,
and Jack and Karen Kay Leonard
for making this website possible.

Major Initiatives:

2009 Indiana Lead-Safe and Healthy Homes Conference

November 4 & 5, 2009

Registration Form

Marten House

1801 W. 86th St.

Indianapolis, IN 46260

Conference Fees

Exhibitors:

$150 for one day/$250 for both days before October 12
$250 for one day/$300 for two days after October 12
Fee includes registration fee for one person
Additional registrations $95 each.

Participants:

· First person from organization: $135 before Oct. 12. After Oct 12, the fee is $160.

· Additional people from organization: $95 before Oct. 12. After Oct. 12, the fee is $135.

Scholarships available--click here

Registration fee excludes hotel rooms. Call 800-736-5634 or 317-872-4111 to reserve a room for $81 while the block lasts

We try to keep it simple. You can register by sending an email to Lauren Stanisic at stanisic@ikecoalition.org with the following information:

Name
Organization
Address
Phone
Fax
Email
Amount Due
Payment Method (check or credit card--include expiration date, mailing address of cardholder and security code please!)
Any Special Arrangements or Needs

You can also use print this page or download registration form in Word and:

Email completed form to Lauren Stanisic at stanisic@ikecoalition.org;
Fax it to IKE at 866-234-8505; or
Mail it to IKE at:

3951 N. Meridian St., Suite 160

Indianapolis, IN 46208

You can register more than one person with one email, but if you use the form, please use one page per person.

We accept checks or credit cards. It is best if payment is received before October 1. If we have to submit invoices after the conference, there is an additional $15 billing fee for each invoice sent.

If you are paying by check, please make check payable to "Lead-Safe Indiana Task Force" and mail it to 3951 N. Meridian St., Suite 160, Indianapolis, IN 46208.

If you are paying by credit card, Visa, American Express and Mastercard are accepted. Please provide credit card number, expiration date, mailing address of cardholder and security code. Improving Kids' Environment, Inc. will process the payment on behalf of the Task Force.

IKE will confirm registrations by email within four business days of receipt. Please contact Janet McCabe at 317-902-3610 or mccabe@ikecoalition.org or Lauren Stanisic at stanisic@ikecoalition.org with any questions or concerns.

NAME ____________________________________________________

ORGANIZATION ____________________________________________

ADDRESS __________________________________________________

CITY_______________________________________________________

STATE, ZIP _________________________________________________

PHONE _____________________ FAX __________________________

E-MAIL ____________________________________________________

Registration Fee $______

I will pay by __ check __ Visa __ Mastercard ___Amex

If paying by credit card, my card # is ______________________________

and my card expiration date is __________________

and my security code is _________

and the mailing address of the cardholder is ____________________________

_____________________________________________________________

If you need special arrangements to attend the conference, please contact Lauren Stanisic at stanisic@ikecoaltion.org or Janet McCabe at 317-902-3610 or mccabe@ikecoalition.org by October 12 so arrangements can be made.

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