2012 COSTHA Forum - Registration Form

2012 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?

Company's Annual Gross Revenue:

Check here if you require special accommodations to fully participate.

I am interested in COSTHA membership - please send me a membership packet today!

	COSTHA Annual Forum & Expo April 22 - 26, 2012 Forum Registration Rates
	COSTHA Members (before March 1, 2012)	$645 - Early Bird Special
	COSTHA Members (after March 1, 2012)	$720
	Non Members (before March 1, 2012)	$775 - Early Bird Special
	Non Members (after March 1, 2012)	$850
	Government Employees (before March 1, 2012)	$450 - Early Bird Special
	Government Employees (after March 1, 2012)	$475

COSTHA's Famous Sunday Night Ice Breaker - April 22
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 - $45.00 per person - Number of People

Sunday, April 22 - concurrent sessions

Yes! I would like to sign up for the Lithium and Nickel Metal Hydride Battery Transport Training
Sunday, April 22, 8:00 a.m. - 12:00 p.m.
Member Rate: $170 for the 1/2 day course
Non-Member Rate: $195 for the 1/2 day course
Government Rate: $195 for the 1/2 day course

Yes! I would like to sign up for the GHS - The Future is Now Training
Sunday, April 22, 8:00 a.m. - 12:00 p.m.
Member Rate: $170 for the 1/2 day course
Non-Member Rate: $195 for the 1/2 day course
Government Rate: $195 for the 1/2 day course

Yes! I would like to sign up for the Packaging Selection & Testing and Best Management Practices Training
Sunday, April 22, 1:00 p.m. - 5:00 p.m.
Member Rate: $170 for the 1/2 day course
Non-Member Rate: $195 for the 1/2 day course
Government Rate: $195 for the 1/2 day course

Monday, April 23 - concurrent sessions

Yes! I would like to sign up for the Limited Quantity - Converting from Consumer Commodity to Limited Quantity Training
Monday, April 23, 8:00 a.m. - 12:00 p.m.
Member Rate: $170 for the 1/2 day course
Non-Member Rate: $195 for the 1/2 day course
Government Rate: $195 for the 1/2 day course

Yes! I would like to sign up for the ADR European Road Regulations Training
Monday, April 23, 9:00 a.m. - 5:00 p.m.
Member Rate: $295 for the full day course
Non-Member Rate: $325 for the full day course
Government Rate: $325 for the full day course

Thursday, April 26 - concurrent session

Yes! I would like to sign up for the Advanced 49 CFR/Air Recurrent Training
Thursday, April 26, 9:00 a.m. - 5:00 p.m.
Member Rate: $295 for the full day course
Non-Member Rate: $325 for the full day course
Government Rate: $325 for the full day course

Sunday, April 22 - Wednesday, April 25

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

Intra-Air Carrier Roundtable (limited to COSTHA Air Carriers Members) - Monday, April 23, 9:00 a.m. - 5:00 p.m.

Multimodal Roundtable - Tuesday, April 24, 4:15 p.m. - 5:30 p.m.

Life Sciences Roundtable - Wednesday, April 25, 1:00 p.m. - 3:00 p.m.

NEW! GHS Roundtable - Wednesday, April 25, 3:00 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 23*

Yes, count me in - I plan to attend the Meet The Regulators Reception Tuesday, April 24*

Yes, count me in - I plan to attend the Luncheon on Tuesday, April 24

Yes, count me in - I plan to attend the Lunch on Wednesday, April 25

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

Cancellation Policy: Cancellations must be received by March 25, 2012 to receive a full refund

Method of Payment

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

Charge to my Visa Mastercard 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

The Annual Forum will be held at The Hilton DeSoto, Savannah, GA
15 East Liberty Street, Savannah, GA 31401
Phone: (912) 232-9000

Please make your reservations directly with the hotel by calling (912) 232-9000 to register. Specify COSTHA Annual Forum attendance for the specially discounted rate of $169 per night single or double occupancy. Make your reservations early to ensure availability at the discount rate.

2012 COSTHA Forum information – Savannah

The Hilton DeSoto Hotel is situated in the heart of Savannah's acclaimed Historic District among the city’s dining, shopping, and theatre districts, and just a short stroll to River Street, City Market, and Forsyth Park. Surrounded by Savannah's beautifully landscaped squares and magnificently restored southern homes of the Colonial and Victorian eras and historic landmarks, the Hilton Savannah DeSoto Hotel is the perfect destination for the 2012 COSTHA Forum. The Hilton’s updated accommodations offer sweeping views of the Historic District. After the business of the day is complete, popular activities are so close to the hotel, including a variety of award-winning restaurants, tours of Historic Savannah, Shopping, and the Theater & the Arts District, City Market and the Savannah riverfront.

The Hilton DeSoto Hotel is convenient to the Savannah/Hilton Head International Airport (just 20 minutes 14 miles away).

Transportation to and from the Airport:

Shuttle Service: Call K-Shuttle (877-243-2050)

Taxi: approximately $25.00

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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