Maine Compost School
 

First Name
Last Name
Title
Company
Street Address
City
State/Province
Postal Code
Country
Country Code (Tel)
Work Phone
Home Phone
Fax
Email
 

Please indicate your preferred Method of Payment:

Check, Please send a check along with a printed copy of this form to the address listed below.
Money Order, Please send a money order along with a printed copy of this form to the address listed below.
Credit Card, Please fill out credit card information and mail a printed copy of this form to the address listed below. Note: Credit card registrations may also be faxed (see below).

Credit Card Number
Credit Card Expiration Date
Name on Card
CV Number from Back of Card
 

Please indicate your preferred Maine Compost School Session:

June 21-25, 2010
October 18-22, 2010
 

Optional Certification Exam

Yes
No

Special Dietary Needs

Vegetarian
Vegan
Other, Please Specify:________________________________

Registrants choosing to use credit cards may fax their registration to Jeanne Pipicello at 207-832-0377

For all other registrations, please print out a completed copy of this form and mail it with payment to:

Jeanne Pipicello
Knox-Lincoln Cooperative Extension
377 Manktown Road
Waldoboro, Maine 04572-5815
Telephone: 207-832-0343
Email:  jeannep@umext.maine.edu

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