To Register print and mail or fax this form to:
Safe-Capture International, Inc.
P.O. Box 206
Mt. Horeb, WI 53572 USA
Fax: (608) 767-3072
Practical Session: Advanced Immobilization Field Techniques
| Program Location: Palmer,
Alaska |
Program Dates:
October 9, 2009 (Friday) |
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| Registrant
Name(s):
_________________________________________________________________________________________________ _________________________________________________________________________________________________ |
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| Agency/Farm/Ranch:
______________________________ |
Mailing Address: ___________________________________ |
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| City: ___________________________ | State: _______ | Zip: _______________ | Tel: ______________________ |
Fax: _______________________________________ |
Email: __________________________________________ |
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** 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 | |
| $625 | $675 |
Total Number of Registrations: _______________ Total Registration Fee enclosed: _______________
(Check, VISA, MasterCard Accepted): Card#: __________________________ Exp: ____________
O This is my first time at a Safe-Capture Workshop. I have also registered for the preceding 16 hour workshop in Anchorage on October 7-8, 2009 (Wednesday/Thursday).
O I have attended the Safe-Capture Workshop in 2007, 2008, or 2009.
O I have previously attended the Safe-Capture Workshop prior to 2007, and will be attending the 16 hour course in Anchorage on October 7-8 (Wednesday/Thursday) as a Refresher.
| 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 |