LOWA Pump out Form

LOWA Septic System Seminar Reservation

If you have a septic tank and wish to learn more about its care,
and if you may desire to benefit from the LOWA pump-out grant,
fill out the form below.

Roadhouse Restaurant, Saturday Oct. 18
Actual Demo: 10 AM
Lecture: 11AM
Lunch: Noon

DIRECTIONS:
From Bagnell Dam: Bus. 54 to W, go 7.2 miles west on W, Roadhouse on left
From Intersection W&Y: Go east 0.1 mile on W, Roadhouse on right

NOTE: to be eligible to participate in grant assistance program, below info marked with an asterick must be complete *
*Your e-mail: *Your Name:

*Your telephone number:

What is your Address:
Street *Address:
*City,State, and Zip:
*County:

I will attend the following meal/demo:
Roadhouse Restaurant

How many will attend?:

COMMENTS:

*Your e-mail:		*Your Name:
*Your telephone number:		What is your Address: Street Address: City,State, and Zip: *County: