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________Connie Combs Clinic May 2-4 2008 _____________________________________________________________
Send this portion with your payment payable to Barrel Clinic by March 15th, 2008.
Name: _____________________________________________________________________________________________
Address:___________________________________________________________________________________________
City, State, Zip ___________________________ __________________________________________________________
Phone__________________________________ Email ______________________________________________________
Mail to: Pam VanKekerix, PO Box 26, Lyons, SD 57041 __________________________________________________________________________________________________
Number of Stalls: ______
Due March 15, 2008 $140.00 = $ ________ Sat Sun
Clinic - May 3-4
Due April 15, 2008 $140.00 = $ ________
Sat Sun Clinic - May 3-4
Due April 15, 2008 $130.00 = $
________ Fri Advance Clinic - May 2
After April 15, 2008 Late fee $ 25.00 = $________
Credit Card payments below
Total Paid: $ __________
Advance Clinic -Returned Students = $130.00
All levels clinic = $280.00
Mail to: Pam VanKekerix, PO Box 26, Lyons,
SD 57041
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| If Paying by Visa, MasterCard, or American Express, Please provide the Following: | |||||
|
Exp. Date: ________________ Amount: __________ x 4%Transaction fee: _______ = Total Amount Due: _____________
Complete and mail with information. |
