Montana Brittany ClubRick Smith’s
Pointing Dog Training Seminar
July 22-25, 2010
Near: Bozeman, MT
Enrollment Form
Please enroll me in the following Rick Smith Intermediate Seminar:
July 22-25, 2010 – Bozeman, MT
Name (as you would like it to appear on Diploma): ________________________
Name (as you would like us to call you and for it to appear on name tag): ________________________
Address: _______________________
_______________________
Phone: _______________________
E-Mail: _______________________
Dog Breed/Age: _______________________
Date/Location where you attended Foundation Seminar: _______________________________________________________________
Tuition: $750.00 ($375 deposit will hold your reservation, balance of $375 due by July 1st or you can pay in full now. Payment will not be cashed/charged until the date of the event.)
Payment of $__________ by:
a) Credit Card (circle one: Visa or MC) Exp Date:____ Sec.Code: ___
Number: ______________________________
Signature: _____________________________
(If using credit card, we need name as shown on card and billing address, if different from above)
Check #: __________ (Payable to Rick Smith - Do not send cash through the mail)
Mail completed enrollment form and payment to:
Bob Myers
3155 Tizer Drive
Helena, MT 59602
(406) 422-0213
MTBC Home