Personal Information
* indicates required information)
| * Your Name | _______________________________________ |
| * Street Address | _______________________________________ |
| * City | _______________________________________ |
| * State or Province | _______________________________________ |
| * Zip | _______________________________________ |
| Country | _______________________________________ |
| * Telephone (Home) | _______________________________________ |
| Telephone (Work) | _______________________________________ |
| E-mail Address | _______________________________________ |
Workshop Information
| Title of Workshop | _______________________________________ |
| Date of Tour (month & year) | _______________________________________ |
Room Type
| ___ Single | ___ I agree to pay the single supplement fee. |
| ___ Double | If you have a preferred roommate, please list their name here _______________ |
Deposits required:
(A tour is greater than 2 days. A workshop is a single day or weekend.)- Tour deposit is 25% of tour cost.
- Workshop deposit is 50% of workshop cost.
Payment Information
To reserve your spot, please complete the following.
I wish to pay by:
| ___ Check. Amount enclosed: ___________
(If submitting the registration form electronically, please send the check within seven (7) days. If we do not receive a check in that time frame, your name will be deleted from our registration list.) |
For office use only Pmt rec'd on_______ Ch#______________ Pmts made: Date______ Amt______ Cancellation Date: Ref_________ Date_____ |
| ___ Credit card: ___ MasterCard ___ VISA | |
| Card Number: _______________________________________ Exp. Date: ____/____ Name as it appears on card: _______________________________________ | |
| ____ I give OSPREY permission to charge my deposit to MasterCard or VISA upon receipt of this registration form. I will send the balance or call OSPREY with credit card information 45 days prior to the workshop or tour. Please sign below if mailing your registration. For electronic registration, the disclosure of your MasterCard/VISA information constitutes permission to make necessary charges against your account. | |
| Signature:_____________________________________________________ | |
| ___ I give OSPREY permission to charge my depositon MasterCard or VISA, and to charge the balance 45 days before the workshop or tour. Please sign below if mailing your registration. For electronic registration, the disclosure of your MasterCard/VISA information constitutes permission to make necessary charges against your account. | |
| Signature:_____________________________________________________ |