DAM SAFETY 2018 REGISTRATION FORM

1 DAM SAFETY 2018 REGISTRATION FORMP lease email the completed form to or fax to You will receive a REGISTRATION confirmation via email. Convenient online REGISTRATION is also available by logging into the ASDSO Portal at Please review the conference cancellation and privacy policy online at A cancellation fee of $100 will be applied to all refunds requested prior to August 31, 2018. No refunds will be given after August 31, 2018. 1. PARTICIPANT INFORMATION Name: First Name for Badge: Title: Date of Birth: / / Organization: Address.

2 City: State: Zip: Work Phone: Cell Phone: Email: 2. FEES (Mark Appropriate fees and total) By Aug.

3 12 After Aug. 12 AmountFull RegistrationASDSO Member: $885 $985 Non-Member $985 $1,085 Honorary Member $125 $125 Student (eligibility guidelines apply) $0 $0 Single Day RateASDSO Member $485/day $535/day Monday (9/10)

4 Tuesday (9/11) Wednesday (9/12) Non-Member $585/day $635/day Monday (9/10) Tuesday (9/11) Wednesday (9/12) Guest REGISTRATION $125 $125 Guest Name: Guest Cell Phone: Guest City: Guest State: Pre-paid Sponsor or Exhibitor $0 $0 Exhibit Booth Staff (Exhibit show access only) $250 $300 Extra Activities Fee Amount 9/9 Sunday Night Kickoff Event: Space Needle $95 9/11 Guest Tour: Seattle Whale Watching $150 9/13 Workshop: On-site Response Guidance for Seepage & Internal Erosion Incidents $200 9/13 Workshop: Dam-Break Flood Modeling/Mapping Using DSS-WISE Lite $300 9/13 Field Trip.

5 Mud Mountain Dam $95 US Citizen Foreign National9/13 Field Trip: Masonry Dam and Cedar River Watershed $95 *If you are attending a field trip please provide your cell phone number aboveFees Total $ 3. ASDSO MEMBERSHIPIf you are not yet an ASDSO member, join now and receive the member REGISTRATION rate!Associate (govt. employee) $55 Affiliate (private sector) Company Member $400 Company Employee $55 Individual Member $100 Student $24 Senior $42 Membership Total $ 4.

6 DONATE TO ASDSOI would like to make a tax deductible contribution to ASDSO in the amount of $ . All donations go to help support the mission of ASDSO. General Donation Memorial Education Fund Bruce Tschantz Public SAFETY at Dams Fund Capital CampaignDonation Total $ *Deductible up to 94% of total 5. form OF PAYMENT Total Payment $ Check Enclosed Govt. Purchase Order Enclosed Credit Card: MC/Visa/AMEX/Discover Card Number: Print Name on Card: CVV: Expiration Date.