Please print and mail with payment or pay below with a credit card (surcharge applies)

Name ______________________________________________________

Address ___________________________________________________
 
City/ST/Zip ________________________________________________

Phone ________________________________ 
 
Email____________________________________________________

                                                                       

                                              Registration                 Registration         Total

# Coming                              Before 1-27-2012         at the door            Due                                                                

_____   Friday night event (no charge)          -0-                                                    -0-                              $   -0-
_____   Lecture/Lunch/Award Banquet           $75                                                 $100                            $_______
_____   Lecture/Lunch @ $50/person            $50                                                  $ 75                            $_______
_____   Award Banquet @ $35/perso             $35                                                  $ 50                           $_______
_____   Trade Show Table @ $25/table          $25                                                                                    $_______
                        + raffle donation                                                

              Total Amount Due                                                                                                               $ ________________
                                                                                                                                                                                        

Payment must accompany registration. Full refund if registration is cancelled by Jan 27, 2012 
 
Mail to:                        Kerry Redente, 12500CR 258, Salida, Co 81201

Before:             Jan 27, 2012

 
To Cancel:       Call Kerry Redente or email ponyxp@msn.com  by Jan 27, 2012 and receive a full refund.

To Register Online Click Here