The Wood River Valley Chapter of the Idaho Master Naturalist Program DATES: January 12th —April 10th, 2010 REGISTRATION INFORMATION Name ____________________________________ email ______________________ Mailing Address _____________________________ City ______________________________________ ST _____ Zip _____________ Phone (Home) __________________
(Cell) _____________________
PAYMENT INFORMATION (COST is $125) Circle Payment type:
Check enclosed
Credit Card:
Visa
or
Mastercard
Name on card ___________________________ Billing Zip Code ___________ Card number ______________________ Exp. Date _______ Security Code _______* * The last three digits of the number on the back of the card Signature ______________________________ I am able to give $_____ extra to help support a scholarship for another participants. (Refunded if not distributed)
TO REGISTER: Send this form to the ERC, P.O. Box 819, Ketchum, Idaho 83340 with your check (or credit card information) by December 18th, 2009. Questions? Lisa Huttinger, ERC, 726-4333; Keri York, Wood River Land Trust, 788-3947
Sawtooth NRA