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

Advanced Immobilization Field Techniques

Program Location: Fairbanks, Alaska
Program Dates: October 2, 2008 (Thursday)
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.

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 Fairbanks on September 30-October 1, 2008 (Tuesday/Wednesday).

O I have attended the Safe-Capture Workshop in 2006, 2007, or 2008.

O I have previously attended the Safe-Capture Workshop prior to 2006, and will be attending the 16 hour course in Fairbanks on September 30-October 1 (Tuesday/Wednesday) 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