PROGRAM REGISTRATION FORM

• Registration must be received at least three working days before the start of the program, and program fee payment is due at time of registration.
• Basic Family Membership entitles participants to the member program rates.
• Refunds, minus a 15% handling fee, are made for cancellations two weeks prior to start of program. No refunds are available if less than two weeks prior to the start of the program.
• Please print, complete and either: Mail to: MNHC, 120 Hickory Street, Missoula, MT, 59801 OR Fax to: 406.327.0421

Program Name

Registrant's Name & Age

Member? (Y/N)

Fee $

Parent or Guardian's Name (for participants under 18)

_______________________________________________________________________

Address ________________________________________________________________

City ________________________________ State ______________ Zip ____________

Phone _______________________

I would like to pay with credit card (circle one): AMEX VISA Mastercard

Account Number ____________________________________ Exp. Date ___________

Signature ______________________________________________________________

Check payable to MNHC enclosed