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Produced Waters Workshob <br />Energy and Water — How Can We Get Both for the Price of One? <br />April 4 -6, 2006 <br />Fort Collins, Colorado <br />Workshop Fee: $125 for early registration by March 3rd <br />Registration Form <br />Name <br />Agency /Company <br />Address 1 <br />Address 2 <br />City, State Zipcode <br />Phone /Fax <br />E -mail <br />Will you attend optional <br />field trip? <br />Special Dietary Needs? <br />ADA (physical or interpre- <br />tive) needs? <br />Check payable to CSU (please note names of participants on <br />the check) mailed to Conference Services, Colorado State University, <br />Fort Collins, CO 80523 -8037 <br />Workshop Fee <br />OR <br />Method of payment <br />Credit Card # <br />circle one: Visa MC Exp. Date <br />Please sign <br />Complete this form and return to CWRRI by fax: 970 -491 -1636. <br />29 <br />