2010 COSTHA Forum - Registration Form

2010 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 April 26 - 28, 2010 Forum Registration Rates
	COSTHA Members (before March 1, 2010)	$595 - Early Bird Special
	COSTHA Members (after March 1, 2010)	$670
	Non Members (before March 1, 2010)	$695 - Early Bird Special
	Non Members (after March 1, 2010)	$770
	Government Employees	$425

COSTHA's Famous Sunday Night Ice Breaker - April 25
Join us for dinner and an adventure and meet your counterparts from around the globe in a small informal environment before the meeting begins. Guests and spouses welcome.
6:00 cocktails (cash bar)
6:30 dinner

Yes! I would like to sign up for the Sunday Night Ice Breaker
Dinner - $35.00 per person - Number of People

Sunday, April 25 - concurrent sessions

Yes! I would like to sign up for the TDG Canada Transborder Compliance Training
Sunday, April 25, 8:00 a.m. - 12:00 p.m.
Member Rate: $145 Non-Member Rate: $175 for the 1/2 day course.

Yes! I would like to sign up for the Safe & Compliant Transportation of Batteries Training
Sunday, April 25, 1:00 p.m. - 5:00 p.m.
Member Rate: $145 Non-Member Rate: $175 for the 1/2 day course.

Monday, April 26 - concurrent sessions

Yes! I would like to sign up for the Professional Development Workshops
Member Rate: $145 Non-Member Rate: $175

Yes! I would like to sign up for the ADR European Road Regulations Training
Member Rate: $245 Non-Member Rate: $275 for the full day course.

Sunday, April 25 - Wednesday, April 28

Included with your registration fee - please advise if you plan to attend:

Intra-Air Carrier Roundtable - Monday, April 26, 8:30 a.m. - 12:00 p.m.

Air Carrier/Shipper Roundtable - Monday, April 26, 1:30 p.m. - 5:00 p.m.

Life Sciences Roundtable - Wednesday, April 28, 1:30 p.m. - 5:00 p.m.

VOHMA/Shippers - Removing Impediments Roundtable - Wednesday, April 28, 1:30 p.m. - 5:00 p.m.

Included with your registration fee - please advise if you plan to attend:

Yes, count me in - I plan to attend the Kick-Off Reception Monday, April 26

Yes, count me in - I plan to attend the Meet The Regulators Reception Tuesday, April 27

Yes, count me in - I plan to attend the Luncheon on Tuesday, April 27

Yes, count me in - I plan to attend the Lunch on Wednesday, April 28

* Spouse/Guest Ticket for two Receptions - $35 for both events

Method of Payment

Check enclosed in the amount of $ (Make check payable to COSTHA)

Charge to my VisaMastercard American Express Discover
$ Amount to be charged

Card number Expiration Date CCV

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 Hilton St. Petersburg Bayfront, 333 1st Street South, St. Petersburg, FL 33701. Phone: 727-894-5000 Fax: 727-823-4797. Please make your reservations directly with the hotel by calling 727-894-5000 to register. Specify COSTHA Annual Forum attendance for the specially discounted rate of $159 per night single or double occupancy. Make your reservations early to ensure availability at the discounted rate.

Hotel Amenities – Fitness Room, Pool, Jogging path along the bay, Hot tub.

The Hilton St. Petersburg Bayfront hotel is located in the waterfront district of downtown St. Petersburg, Florida. Downtown St. Petersburg is home to many of the finest cultural attractions in Florida, all conveniently located just outside the hotel's front doors. Step outside and you'll find:

Baywalk Entertainment Complex
Art Galleries
Florida Holocaust Museum
Fort DeSoto Beaches
Jannus Landing
The Pier
Antique Shopping
Salvador Dali Museum
Mahaffey Theater
St. Petersburg Museum of Fine Arts

Tampa International Airport (Super Shuttle= Approximately $20, Cabs= Approximately $40).

St. Petersburg-Clearwater International Airport (Cabs= Approximately $30)

Albert Whitted Airport (Approximately 1 mile to hotel )

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

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