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Your Name:
Street Address:
City, State, Zip:
Telephone:
In case we need to contact you
Your email:
Please make sure
it's correct!

 Your Event Registration is not complete unless you receive a confirmation via email

Events you are registering for (mark all that apply):
  Household Hazardous Waste Collection Days
 

    May 15, 2010, 8am - 12pm     Schaghticoke Highway Garage, Route 67
      Sept. 18, 2010, 8am - 12pm    Nassau Village Hall
Items you will be disposing of:
 
 

Please list all items you plan to bring to each event, along with the quantity of each item.
This information is required for registration. Be sure you've checked the
box(es) for the event(s) you plan to attend!
1. Household Hazardous Waste Collection Day - May

2. Household Hazardous Waste Collection Day - September

Comments and questions:

Please send in your registration form by clicking the Submit button below.
Thank you!

Your Event Registration is not complete unless you receive a confirmation via email

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