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 Animals: Multi-Species

O Chemical Immobilization of Non-Human Primates

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!)

General Registration must be postmarked less than 30 days prior to the program date.
Walk-In Registration will be accepted if space is available

Early Registration  General Registration  Refresher
For previous participants who would like to attend again
$725 $775 $495

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