To Register print and mail or fax this form to:
Safe-Capture International, Inc.
P.O. Box 216
Snohomish, WA 98291 USA
Advanced Immobilization Field Techniques "Hands On" Class
|Program Location: Brenham, Texas
March 6, 2014 (Thursday)
Mailing Address: ___________________________________
|City: ___________________________||State: _______||Zip: _______________||Tel: ______________________|
** 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.
|Early Registration||General Registration|
Total Number of Registrations: _______________ Total Registration Fee enclosed: _______________
(Check, VISA, MasterCard Accepted): Card#: __________________________ Exp: ____________ Name on Card:___________________________
OThis is my first time at a Safe-Capture Workshop. I have also registered for the Safe-Capture 16 hour Chemical Immobilization workshop, which I will be attending prior to the March 6, 2014 date of the Advanced Techniques class.
OI have previously attended the Safe-Capture 16 hour Chemical Immobilization workshop after March 2011.
OI have previously attended the Safe-Capture 16 hour Chemical Immobilization workshop prior to March 2011, and will be attending again as a Refresher prior to the March 6, 2014 date of the Advanced Techniques class.
|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|