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Rater Fest 2010 Registration

*Required fields.
Name:
Company Name:
Address:
City:
State:
Zip:
Email Address:
Phone:
Alternate Phone:
Who Will Attend?
   # of Raters:    # of Other Adults:    # of Children:
Please list names of attendees here:
Any dietary restrictions?
Will you be camping or lodging locally?
Camping
Lodging in a Local Motel/Hotel/B&B
Other Arrangements
What are you hoping to learn from this event:
Other comments or questions:
All-Inclusive Registration Fees
Rater: $300
Each additional adult: $75
Each additional child (ages 4-12): $25
Each additional child (3 and under): Free

Total Payment Amount:
*Payment Method
Check Payable to "EnergyLogic, Inc". Please mail payment to:
EnergyLogic Inc.
P.O.Box N
Berthoud, CO 80513
Credit Card Please call 800.315.0459 x719 or x734 to submit your Visa or Mastercard information over the phone.
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