Please print this form and mail to:
Linda Carman
18 Fenmore Drive
Wappingers Falls, NY 12590
Email copies are preferred, and should be sent to samtasia@aol.com
PLEASE REGISTER
Registration helps us get your
name tag printed, sort your banquet and seminar tickets, and speed you
through the welcoming process.
Fill out one form for each member of your party
that is attending!
Show your name as you would like it to appear
on your badge.
| Name |
_________________________________ |
| Street |
_________________________________ |
| City, ST, Zipcode |
____________________________________________________________ |
| Home Phone |
_____________________________ |
| Cell Phone |
_____________________________ |
|
_____________________________ |
|
| Kennel Name |
_____________________________ |
| Special Needs |
____________________________________________________________ ____________________________________________________________ |
| Staying At |
_____________________________________________ |
| Number of Dogs |
________________ |
| Arrival Date |
____________________________ |
| Departure Date |
____________________________ |
| Emergency Contact: | |
| Name: |
____________________________ |
| Relationship: |
____________________________ |
| Phone: |
____________________________ |