Conference Registration Form

Name:
Affiliation:
Address:
City: State: Zip:
County:
Phone: Fax:
Email:
 
Please circle below
Friday Icebreaker Yes No  
RROKI Field Trip Yes No  
Staying at Conference Hotel Yes No  
Banquet at Hotel (included in registration) Yes No  
 
Additional guests for Banquet ($30 for each guest) How Many?
Registration:
Postmarked after 9/25/08 $110.00  
Walk-in $120.00  
Exhibit / Vendor Table $20.00  
 
Total Enclosed $  
 
bullet Accepting Checks, Money Orders
bullet Make checks payable to RROKI
bullet DO NOT MAIL CASH
bullet No refunds after 9/13/08

Return this form with payment to:

Raptor Rehabilitation of Kentucky, Inc.
P.O. Box 18002
Louisville, KY 40261