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Registration Form: Local Working Group Meeting (Kennebec and Lincoln Counties)
Date:
December 17, 2024
Time:
Noon - 2 pm
Location:
Augusta City Hall (16 Cony Street in Augusta)
Registration Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Preferred Phone Number
*
County
*
select one
Kennebec
Lincoln
Affiliation - Employer, Business/Farm Name, etc.
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Preferred Communication Method
*
In the case of inclement weather causing us to shift online to Zoom, what is the best way to reach you?
Phone call
Text
Email
How did you hear about the local working group meeting?
*
Knox-Lincoln SWCD website
Knox-Lincoln SWCD Email/Newsletter
Social Media
Google
Referred by a friend, family member, colleague, etc.
Press Release in Local Newspaper (online or print)
Other
Would you like to sign up for the Knox-Lincoln SWCD e-newsletter?
We send an average of 1-3 emails per month.
Yes, please sign me up to receive the KLSWCD e-newsletter!
Would you like to register additional guest(s)?
*
You will be asked to provide their names and contact information below.
select one
No, I'm just registering myself
Yes, one more guest
Yes, two more guests
Yes, three more guests
Yes, four or more guests
Guest #1 Information
Please provide contact information for the additional guest below
Guest #1 Name
*
First Name
Last Name
Guest #1 Email
*
Verify Email
*
Guest #1 Phone
Guest #1 County
*
select one
Kennebec
Lincoln
Guest #2 Information
Please provide contact information for the additional guest below
Guest #2 Name
*
First Name
Last Name
Guest #2 Email
*
Verify Email
*
Guest #2 Phone
Guest #2 County
*
select one
Kennebec
Lincoln
Guest #3 Information
Please provide contact information for the additional guest below
Guest #3 Name
*
First Name
Last Name
Guest #3 Email
*
Verify Email
*
Guest #3 Phone
Guest #3 County
*
select one
Kennebec
Lincoln
Additional Guests
For any additional guests not listed above, please name, email, and county below