2017 COOLWATER FISH CULTURE WORKSHOP January 9th – 11th 2017 Double Tree by Hilton, South Bend, Indiana Registration Form NAME: _______________________________________________________________________ AFFILIATION/AGENCY: __________________________________________________________ ADDRESS: _____________________________________________________________________ CITY, STATE, ZIP CODE: __________________________________________________________ PHONE: ______________________ EMAIL ADDRESS: ________________________________ $70 Early registration enclosed (received by December 10th, 2016) $80 Registration enclosed (received on or after December 11th, 2016) $80 To be paid on arrival, registration form attached by email
Please submit this form and a check payable to “Coolwater Workshop” to: Randy Lang Cikana State Fish Hatchery 2650 St. Rd. 44 Martinsville, IN 46151 Please submit any electronic forms by email to:
[email protected]
