2012 HHW PRE-REGISTRATION FORM

    Print, complete and mail this form along with your $5.00 payment to:
    (Note: Only cash or checks are accepted)

Dutchess County Resource Recovery Agency
96 Sand Dock Road
Poughkeepsie, NY 12601
If you have any questions, call us at 845-486-7340 or 845-463-6020
DATE ___________________________
NAME ___________________________________________________
ADDRESS ___________________________________________________
___________________________________________________
PHONE# ___________________________
   
DATE OF EVENT ___________________________

REQUESTED APPOINTMENT TIME (Please Circle)
7:30AM
 8AM 8:30AM 9AM