To Register print and mail or fax this form to:

Safe-Capture International, Inc.
P.O. Box 216
Snohomish, WA 98291 USA
Fax: 1-425-948-7952


Register For: 
O Chemical Immobilization of Deer & Elk

O Artificial Insemination of White-tailed Deer



Program Location: _______________________________

Program Dates: __________________________________

Registrant Name(s): __________________________________________________________________________________

_________________________________________________________________________________________________

Agency/Farm/Ranch: ______________________________

Mailing Address: ___________________________________

City: ___________________________ State: _______ Zip: _______________ Tel: ______________________

Fax: _______________________________________

Email: __________________________________________

** Early Registration Fee: (Save $50 if you register more than 30 days prior to the program date!)

Early Registration General Registration Refresher
O Chemical Immobilization of Deer & Elk $725 $775 $395
O Artificial Insemination of White-tailed Deer $825 $875 $450

Total Number of Registrations: _______________         Total Registration Fee enclosed: _______________

(Check, VISA, MasterCard Accepted): Card#: __________________________ Exp: ____________

  If you cannot attend this program, but would like to be on a mailing list for future programs, please check here and return this form