Document 2jD0RRZdEjRobp9N6Ded6KdRL

IPf:' IN DEPEN DEN T PETROLEUM A SSO CIA T IO N OP AM ER ICA w Ml participant registration information Due to limited space, only two registrants per member company allowed. NAME TITLE ADDRESS CITY/STATE/ZIP PHONE EMAIL ASSISTANT'S NAME NICKNAME FOR BADGE COMPANY EMAIL FAX EMAIL Event participation These functions are only available to those who piers to participate In IPAA organized meetings. Please indicate which meals you plan to attend. Breakfasts and Dinner are limited to Call-Up participants only. Monday, March 5 Tuesday, March 8 Wednesday, March 7 ___Call-Up Orientation ___Policy Breakfast ___EPA Policy Meeting ___Reception/Dinner ___Congressional Reception ___ Debrief Meeting The Call-Up requires a considerable amount of walking. List any special needs._________________ participant Corporate information The following information will help IPAA schedule you with the most appropriate members of Congress. How many people does your company employ?. Which state(s) does your company have production?. What federal issues are important to your company and why?. FAX TO: (202) 293-0681 SCAN AND EMAIL TO: kdaugherty@ipaa.org Questions? Call or Email Keely Daugherty | kdaugherty@ipaa.org (800) 433-2851 IPAA Member $0 Cooperating Association* $0 ^Cooperating Associations receive up to two complimentary registrations. Additional registrations will be $450, which includes a one-year membership. TOTALS__________ CHECK ENCLOSED $ . CREDIT CARD: VISA MC AMEX CREDIT CARD # EXP. DATE CARDHOLDER NAME 1201 15th Street, NW, Suite 300 | Washington, DC 20005 j 800-433-2851 Sierra Club v. EPA 18cv3472 NDCA Prod 1 ED 002061 00059471-00001