Illinois Basin Event Illinois Basin Event Registration Wednesday, September 28, 2022 Name(Required) First Last Title Organization(Required) Email(Required) PhoneZip Code(Required)What kind of entity are you?(Required)Choose the one most appropriate.-GovernmentBusiness / IndustryNonprofitAcademiaTribalLabor / UnionPhilanthropyNews MediaOtherWill you attend the VIP roundtable session?(Required) Yes No Will you attend the VIP reception?(Required) Yes No Do you have any dietary restrictions?Consent to recording(Required)I hereby give my consent for my image and likeness to be videotaped, audiotaped, or photographed during this event. I further authorize the Interagency Working Group on Coal and Power Plant Communities (IWG), including the National Energy Technology Laboratory (NETL) and other IWG partner agencies, to use this electronic media and/or photographs in any manner—whole, or in part—with no expectation to inspect or approve any use. I also consent for the IWG and/or NETL to use any questions or comments I provide during the event in future materials and/or publications. I agree to the statement above.