Registration Form


2006 COSTHA Annual Forum & Expo
(please print or type all information)

Name
Nickname for badge
Title
Company
COSTHA Member?  Yes   No
Street address
City
State/Province
Zip/Postal code
Country
Phone:
Fax:
Email:
No. of years in the HazMat/DG transportation industry?
 Check here if you require special accommodations to fully participate.
 I am interested in COSTHA membership - please send me a membership packet today!
Two day COSTHA Annual Forum & Expo
March 14-15, 2006
Forum Registration Rates
COSTHA Members $525
Non Members $625
Government Employees $375

Register for a training course and save!
Sign up for any of the training courses listed below and save $25 on the Annual Forum & Expo registration fee!

Sunday Night Dinner Cruise
$49 Per Person - Number of People Attending:
Sunday, March 12 - concurrent sessions
Yes! I would like to sign up for the training "TDG Transborder Compliance Training"
Member Rate: $195 Non-Member Rate: $245 for the 1 day course.
Yes! I would like to sign up for the training "Automotive Issues and Best Practices for HazMat Transportation"
Member Rate: $95 Non-Member Rate: $125 for the 1/2 day course.
Monday, March 13 - concurrent sessions
Yes! I would like to sign up for the training "49 CFR Hazardous Material Transportation Recurrent Training" 
Member Rate: $195 Non-Member Rate: $245 for the 1 day course.
Yes! I would like to sign up for the training "Hazardous Waste Training"
Member Rate: $95 Non- Member Rate: $125 for the 1/2 day course.
Yes! I would like to sign up for the training "Safety Compliance for Motor Carriers"
Member Rate: $95 Non-Member Rate: $125 for the 1/2 day course.
Included with your registration fee - please advise if you plan to attend:
Yes, count me in - I plan to attend the Kick-Off Reception March 13th
Yes, count me in - I plan to attend the Meet The Regulators Reception March 14th
Yes, count me in - I plan to attend the Luncheon on March 14th
Yes, count me in - I plan to attend the Luncheon on March 15th
Yes, count me in - Pharmaceutical Roundtable - Weds., March 15 - 3:00 p.m. - 5:00 p.m.
Method of Payment
Check enclosed in the amount of $ (Make check payable to COSTHA)
Charge to my VisaMastercard American Express 
$ Amount to be charged
Card number Expiration Date
 Send me an invoice
Return this form to:
COSTHA
7803 Hill House Court
Fairfax Station, VA 22039
Phone: (703) 451-4031
Fax: (703) 451-4207
Annual forum to be held at the Omni Austin Hotel Downtown, 700 San Jacinto at 8th Street, Austin, TX 78701, Phone: (512) 476-3700. Please make your reservations directly with the hotel by calling 1-800-THE-OMNI (843-6664) or 512-476-3700 to register. Specify COSTHA Annual Forum attendance for the specially discounted rate of $149 per night single or double occupancy. Make your reservation today to ensure availability.

The hotel recommends SuperShuttle for transportation from the airport (Phone: 800-258-3826). The fee is $11.00 each way. From the Airport - Upon arrival at the airport, follow signs from baggage claim to the SuperShuttle ticket counter. No reservation is necessary and service is available 24 hours a day, 365 days a year. To the Airport – Call (512) 258-3826, 24 hours in advance for reservations, or check with the concierge or front desk of your hotel.


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COSTHA


The Council on Safe Transportation of Hazardous Articles
7803 Hill House Court
Fairfax Station, VA 22039
Phone:  703/451-4031   Fax:  703/451-4207   
Email: mail@costha.com