Registration Form

Please fill in the following information and return it by fax, or send the complete information by electronic mail, before January 24, 2003, to:

Francine Laperrière, Transboundary Movement Branch
Environment Canada, Ottawa, Ontario, K1A 0H3
Fax: 819-997-3068
E-mail: AdminPCB@ec.gc.ca

Name (in full):
______________________________
Organization or company:
______________________________
Address:
______________________________
Tel: ( ) ______________
fax: ( ) ______________
E-mail:
______________________________

Please indicate if:

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