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Name: __________________________________________ Sex: ____
Age: _________
Address:
______________________________________________________________
City: ______________________________________ State:
_____ Zip: ___________
Phone: (Home) _________________________ (Work)
_________________________
Parent Name:
___________________________________________________________
Check Camp Week & Dates (Indicate first &
second choice)
| Camp Date |
1st |
2nd |
|
Camp Date |
1st |
2nd |
| June 1-3, 2004 |
( ) |
( ) |
|
June 14-16, 2004 (Girls) |
( ) |
( ) |
| June 7-9, 2004 |
( ) |
( ) |
|
June 21-23, 2004 |
( ) |
( ) |
Signature of Parent or Guardian required if under 18
years of age:
_____________________________________________________________________
Indicate breed you show:
_________________________________________________
Check # ________________ Amount:
_______________$100.00 due with registration.
Make Checks Payable to
Premier Cattle Services
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