Please fill out the registration form below, or download our printer-friendly form:

Registration Form (35Kb PDF)

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1. Your contact information
*First name:
*Last name:
Affiliation:
*Address 1:
Address 2:
*City:
*State/Province:
*Postal Code:
Country:
*Phone:
Fax:
*E-mail:
  
2. Payment information
*Registration type:
Not sure of your
NHA membership status?
$300 - NHA Member (subject to verification)
$350 - Non-member
*Credit card:Visa
Mastercard
American Express
Discover
*Account:
*Name on card:
*Expiration:/
  
3. Other information
Are you a member of the Renewable Hydrogen Working Group?yes no
Are you interested in more information about the Renewable Hydrogen Working Group?yesno
Do you require vegetarian meals?yesno
Do you want your name and email address distributed to all attendees?yesno