Organic Trade Association

April 14 & 15, 2010 Hall of States, Washington DC

*First Name:		*Last Name:
*Title:		*Company:
*Address:		*City:
*State:		*Zip:
*Phone:		*E-Mail:
*Please check one of the following
I am mailing my $250 registration fee by mail with check/credit card along with this form. (Please print and mail or fax this form to address below to attention Marissa Potter).
I am paying my $250 registration fee with a credit card over the internet.
Payment Information (If paying by credit card)
Card Type:
Name on card:
Card Number:
Expiration Date:
Billing Zip Code:
Please check all that apply
Yes, I plan to attend the Policy Conference.
Yes, I plan to attend the Reception.
Yes, I plan to participate in the Hill Visit Days. I understand that OTA will be scheduling my meetings with congressional offices for the day.

Details subject to change
In-person meetings of OTA’s Board of Directors are open to any member who wishes to observe this aspect of the association’s governance. The Board may hold some portions of the meeting in executive session. For more information about the April 13 meeting agenda, please contact David Gagnon.
Registration confirmation and additional information will be sent one week prior to the event.

Phone: 413-376-1231 \| Fax: 413-774-6432 60 Wells Street \| Greenfield, MA 01301 \| mpotter@ota.com