NJDEP

CRTK Survey Workshops
Wednesday, January 20, 2010(9:30am - 12:00pm)
Tuesday, February 9, 2010(9:30am - 12:00pm)

Department of Environmental Protection
401 East State Street
1st Floor, Public Hearing Room
Trenton, New Jersey 08625-0405

If you plan to attend a workshop, you must register by completing and submitting the form below to the Community Right to Know Program.
Workshops will be canceled and rescheduled if state offices are closed or opening is delayed.

Register for the Workshops by completing this form:

Name:	*First Name *Last Name
Date Attending:	*Please check one box January 20th 9:30am-12pm February 9th 9:30am-12pm
Company Name:	Number of attendees
Address:
P.O. Box:
City:	State:
Zip:
Internet Email Address: *
Phone No.:	Fax No.:
*Fields marked with are required.**