REGISTRATION FORM

AK-CMK-2009
Preservation Breeding Symposium – Redmond, Oregon
August 28-30, 2009


Please indicate if you are new to Al Khamsa or CMK _____ or if this will be your first convention ____.
Name(s)__________________________________________________________________________
Address___________________________________________________________________________
City ______________________________State or Province/Country/Zip________________________
Telephone__________________________________Mobile___________________________________
Email_____________________________________Website__________________________________

Full registration fee includes snacks on Friday night, Saturday lunch and banquet
and admission to all events.

_____ check here if you have any dietary restrictions _____ vegetarian _____ other _______

__________________________________________________________________________________

Fees
in US Dollars

Adults                                                        $125.00

Young Adults – 13-18                                    $70.00
 
Children – 6-12                                             $35.00
 
Children 5 and under                                         Free
 
Late Fees (after June 26, 2009)
Adults                                                           $25.00
 
Fees for Saturday only and Banquet                 $90.00
 
Fantasia only – no food provided                        $5.00

__________________________________________________________________________________

Make checks payable to CenPAK, Inc.
 
or provide charge card information:

 

Number of Adults  ________________          Visa/MC number_______________________________
Number of Children_______________           Expiration Date__________________                         Full Weekend ___________________            Signature ____________________________________    Saturday only __________________                                                                                        Fantasia only ___________________

Total Amount Due ________________ 

 Print out this form and send to the address below:  

Carol Tummonds, Registrar
3430 NW Canal Blvd., Redmond, Oregon 97756
1-541-526-0989 Fax: 1-541-526-0989 
dctired2@bendbroadband.com