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 Visa Mastercard
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.