Registration Form

First Name:*	Last Name:*

Company	Email Address*	Daytime Telephone Number*
		(i.e. 000-000-0000)
Address*	City*	State*	Zip*

Payment Information (Registration fee includes continental breakfast, lunch, and afternoon refreshments)* $60.00


Make check or money order payable to: LA DEQ Green Business Expo Mail payment and acknowledgement form to: Ms. Terry Thomas, Louisiana Department of Environmental Quality, P. O. Box 4303, Baton Rouge, LA 70821-4303

Cancellation Policy Registration fee is non-refundable. Substitutions will be accepted for registrants unable to attend. If possible, please submit the name of your substitute to Ms. Terry Thomas at (225) 219-3840 or terry.thomas@la.gov.
Lunch Information Catered by La Madeleine French Bakery & Cafe
RSVP: YES NO
Boxed Lunch Selections (Select one)* Roast Beef Poboy Chicken Salad Croissant Vegetarian Sandwich

Submit
* Required

Louisiana Department of Environmental Quality 602 N. Fifth Street Baton Rouge, LA 70802
Call or e-mail a hotline · Office Address/Phone listing · Locate a DEQ employee
Call 1-866-896-LDEQ or e-mail our Customer Service Center with questions or comments