Radon Measurement Registration Form

Name:___________________________________________Facility:______________________________________

Address:_____________________________City:________________Postal Code:__________________

Phone:____________________________ E-mail:____________________________________________

This address is:  Business:  or   Home:
Course fee $495.00 or $429.00 if you register 30 days or more in advance.

 Ottawa - October, 2010

 Kamloops - November, 2010

 NEHA exam (optional) $130.00
National Environmental Health Association (NEHA) National Radon Proficiency Program

For U.S. participants the course fees are the same in US dollars.

The fee includes 16 hours of instruction, interaction and practical hands-on sessions, 200 page manual, marketing video, lunch both days and GST.

Payment by cheque or credit card must accompany the registration to ensure a space in the course.

Visa         MasterCard      American Express   Cheque enclosed
                                                                                   

Card number:_____________________________________________________________ 

Expiry  date:_______________ Name on Credit Card:__________________________________

Signature:_______________________________________________

Print and complete the registration form. Fax to 613-256-5872 or E-mail information to course@biomation.com  
or mail to:

BIOMATION 335 Perth St. P.O. Box 335 Almonte, ON   K0A 1A0

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