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Conference Registration

Team size may consist of any number of individuals.

First Name:
Last Name:
Home Address:
City:
State:
Zip Code:	(5 digits)
Cell Phone:
Email:
School District:
School Building:
T-Shirt Size:

A confirmation e-mail of individual acceptance will be sent to you within 72 hours.
*If you do not receive your confirmation within this time call: Rod Volk at 701-412-3323

Registration fee is $150 per person.

Payment must be received by April 15th, 2013.
Make payment out to: Roughrider Health Promotion

Send payment to:
Rod Volk – Roughrider President
302 12th Ave. North
Casselton, ND. 58012

Each participant will attend every session offered so there is no list to pick from.

NOTE: The conference often fills before deadline as space is limited, so we encourage you to complete your registration and send your payment as soon as possible.

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