Registration Form- October 18-19, 2003 - Oregon State 4-H ...

Fee and Payment Form
Oregon 4-H Master Shooting Sports and Western Action Shooting Training Weekend
Option 1: Friday evening and Saturday $ 95.00 (a) $ _______
Option 2: Discipline training only (Saturday) $ 45.00 (b) $ _______
Option 3: Western Action Shooting (includes Western Heritage Project Book) $ 120.00 (c) $ _______
Registrations accepted through 5:00 PM, February 27, 2013
Total Registration Fees are due with this form. Please add lines (a-c) TOTAL ENCLOSED = $ _______
Fees are non-refundable February 28 or later.
Payment must accompany this registration form.
Make checks payable toOregon Outdoor Education & Recreation.
Registration deadline is 5:00 PM, February 27. Mail to: Shooting Sports Registrar, 3893 SW Airport Way,
Redmond, Oregon 97756-8697
Oregon 4-H State Shooting Sports Credit Card Form
Name (printed):_______________________________
County: _________________
Phone: __________________________
Total Amount of payment: _________
Credit card: □ VISA □ Master Card □ Discover Card □ American Express
Credit Card Number ______________________________ Expiration Date ________
Signature ______________________________________ Date _________________
Payment can be mailed to: Outdoor Education & Recreation, 3893 SW Airport Way, Redmond, OR 97756
Payment can be faxed to: Outdoor Education & Recreation, 541-548-8919
Payment can be scanned to: david.white@oregonstate.edu
SEND THE FEE AND PAYMENT FORM WITH THE REGISTRATION
Oregon State University Extension Service offers educational programs, activities, and materials--without regard to race, color, religion, sex, sexual orientation,
national origin, age, marital status, disability, and disabled veteran or Vietnam-era veteran status--as required by Title VI of the Civil Rights Act of 1964, Title IX of the
Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973. Oregon State University Extension Service is an Equal Opportunity Employer.
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