2023 Hill Day Registration: Geothermal Industry Professional

Geothermal Rising: Capitol Hill Day 2023

Geothermal Industry Professional Registration
Name*

First NameLast Name
Position/Title*
Organization/Business*
Email Address*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Primary Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dietary Restrictions:

Dairy FreeGluten FreePescatarianVeganVegetarianOther
Other Dietary Restrictions:
How many years have you been in the geothermal industry*
Select the best option that describes your field within the industry:*

Academic InstitutionCarbon Capture Utilization & StorageConsultingDirect UseDrilling ServicesEnergy StorageExplorationGeothermal Ground Source Heat PumpsGeothermal Power OperatorGeothermal Service ProviderGovernmentHydrogenNational Lab/SurveyOil & GasPR/Media/MarketingProject ManagementThink Tank/NGOUtilityWell TestingOther
Will you be participating in Hill Day appointments on Tuesday, June 6?*

YesNo
Are you a U.S. Military Veteran?

Yes, I am a Veteran.
In what congressional district(s) do you or your company have projects?*
Do you want to attend meetings with congressional offices in this/these districts?*

YesNo
Are there any congressional offices with whom you have a relationship?*

YesNo
Please list any congressional offices you have relationships with and tell us how you know them:
By checking this box you agree to participate in the in-person meetings scheduled to the best of your ability.*

I agree.

Your support is crucial is helping build public awareness of Geothermal Energy and new technologies. Please choose your donation preference(s) below:

GR Traveling Museum Exhibit Fund

$25.00 Quantity

GR Traveling Museum Exhibit Fund

$50.00 Quantity

GR Earth Energy Fellows Fund

$25.00 Quantity

GR Earth Energy Fellows Fund

$50.00 Quantity

GR Regional Interest Group Fund

$25.00 Quantity

GR Regional Interest Group Fund

$50.00 Quantity

No Donation at this time

$ Free Quantity

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Although there is no registration fee for participation, the inaugural Geothermal Hill Day is generating a lot of interest within the geothermal community. As such, we anticipate the event will sell out. Individuals that register for the event but do not show up or cancel less than 72 hours prior to the scheduled start time, will be charged a cancellation fee. By checking below, you agree to the cancellation terms listed above and authorize the charge to your credit card if you do not show up or cancel less than 72 hours prior to the event.*

I agree to the cancellation terms above
Should be Empty:

Geothermal Rising: Capitol Hill Day 2023