NAME_________________________________________________________

 

ORGANIZATION_________________________________________________

 

ADDRESS______________________________________________________

 

_______________________________________________________________

PHONE ______________________________E-Mail_____________________

Will you need any special accomodations in the meeting facility? _________



 
  
$100 deposit reserves your seat. 

(remaining $525 due on day of the event) 

 

 

 For Credit Card Payments:

Card Type: (VISA or Master Card) ______________________

Card Number:___________________ Expiration Date:_________

Security Code:___________________

 _________________________________________________
Signature

 
Print and mail this registration form (with deposit) to

Madonna M. Carlson
1515 Timber Lane
Fort Dodge, Iowa   50501

-----------------------------------------------------------------------------------------------
NOTE:  Willmar is surrounded by beautiful walleye fishing lakes.  If you are interested in a group fishing trip in conjunction with this training, just let us know!   

To check on alternate training dates, on-site training or group discounts for your organization, contact me by email