2004 COACH WYATT CLINICS PRE-REGISTRATION FORM MAIL WITH CHECK OR P.O. TO COACH HUGH WYATT - 1503 NE 6TH AVENUE - CAMAS, WA 98607 PURCHASE ORDERS MAY BE E-MAILED TO coachwyatt@aol.com (OR FAXED TO 360-834-0718) CANCELLATION policy - NO REFUNDS for cancellations less than seven days prior to the clinic date - BUT fee can be applied to registration for a later 2003 clinic CLINIC LOCATION:______________________________________________ SCHOOL/ORGANIZATION_______________________________________________________ SCHOOL PO # (IF THIS IS TO BE BILLED TO SCHOOL) _________________________________ BILLING ADDRESS________________________________________________________________________ ___________________________________________________________________________ NO. OF COACHES @ $75 PRE-REGISTRATION__________TOTAL AMOUNT ________________ (MAKE P.O., CHECK OR MONEY ORDER PAYABLE TO "COACH HUGH WYATT") Sorry - no refunds of pre-registration fees will be made for cancellations within 7 days of the clinic date COACH(ES) WHO WILL BE ATTENDING (PLEASE PRINT - WE WILL USE THIS TO MAKE NAME BADGES): _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ SEND CONFIRMATION TO (WILL BE SENT BY E-MAIL UNLESS YOU REQUEST OTHERWISE) NAME: ADDRESS: CITY/STATE/ZIP: HOME PHONE: E-MAIL:     WORK PHONE: TOPIC(S) OF PARTICULAR INTEREST TO YOU: