2005 COACH WYATT CLINICS PRE-REGISTRATION FORM MAIL WITH CHECK OR P.O. TO COACH HUGH WYATT - 1503 NE 6TH AVENUE - CAMAS, WA 98607 $75 PREREGISTERED - 10+ DAYS IN ADVANCE ($100 AT THE DOOR) PURCHASE ORDERS MAY BE E-MAILED TO coachwyatt@aol.com (OR FAXED TO 360-834-0718) PLEASE READ CAREFULLY - the pre-payment discount is offered in order to assist us with our planning - therefore, no refunds of pre-registration fees will be made for cancellations within 10 days of the clinic date CLINIC LOCATION:_________________________________________________ NAME _______________________________________________________________________ ADDRESS ________________________________________________________________________ CITY/STATE/ZIP ________________________________________________________________________ PHONE ____________________________________________________________________ E-MAIL ADDRESS ___________________________________________________________ SCHOOL/ORGANIZATION _____________________________________________________ NO. OF COACHES @ $75 PRE-REGISTRATION__________TOTAL AMOUNT ________________ (MAKE P.O., CHECK OR MONEY ORDER PAYABLE TO "COACH HUGH WYATT") COACH(ES) WHO WILL BE ATTENDING (PLEASE PRINT - WE WILL USE THIS TO MAKE NAME BADGES): _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ PLEASE READ CAREFULLY - the pre-payment discount is offered in order to assist us with our planning - therefore, no refunds of pre-registration fees will be made for cancellations within 10 days of the clinic date