2010 HHW PRE-REGISTRATION FORM

Print, complete and mail this form along with your $5.00 payment to:

Dutchess County Resource Recovery Agency
96 Sand Dock Road
Poughkeepsie, NY 12601
You will receive a confirmation of receipt along with directions to the
event and a complete list of What To Bring and What Not To Bring.

Please read carefully – we cannot make exceptions to this list.  Appointment requests
will be best accommodated as available.  You must show your confirmation to
attend the Event.  If you do not receive a confirmation, call DCRRA at 463-6020.

DATE ___________________________
NAME ___________________________________________________
ADDRESS ___________________________________________________
___________________________________________________
PHONE# ___________________________
EMAIL ___________________________
DATE OF EVENT ___________________________
REQUESTED APPOINTMENT TIME (Please Circle)
7:30AM
 8AM 8:30AM 9AM