2005 Western Canadian Orienteering Championships

7-8-9-10 October 2005

Registration Form

Contact Name:_________________________________________________

Address:______________________________________________________

              ______________________________________________________

              ______________________________________________________

Phone No: ____________________________________________________

Email: ________________________________________________________

Club:_________________________________________________________

Registration

Name

Category

 SI Number or Rent

Sprint

 WCOC Day 1

WCOC Day 2

 MOC

Total

Fees:                   12 & Under
13 to 19
20 & over
Wayfaring

$5
$5
$5
$10		 $5
$10
$25
$10		 $5
$10
$25
$10		 $5
$10
$15
$10		  
               
               
               
               
               
Banquet Tickets Adult - $20 Each Quantity:    
Banquet Tickets Child (12 and under) - $12 Each Quantity:    
T-Shirts: - $19 Each Small: Med: Large: XL:  
Sport Ident Rental - Days - $3 /day/person

Quantity:

    
Sport Ident Rental - All 4 days $10

Quantity:

    

Late Fee, postmarked after 31 August ($5 per competition day/person)

  

Total Fees

  

You may pay by VISA or MasterCard or cheque (Payable to Manitoba Orienteering Association):

Visa:____  MasterCard:_____  Card Number:________________________  Expiry Date:_______________

I authorize the MOA to charge the Total Fees to the above card:
______________________________________________
Cardholder Signature

Mail above form and payment to:

Manitoba Orienteering Association
200 Main  Street
Winnipeg, Manitoba
R3C 4M2

All competitors will be required to sign a waiver of liability prior to starting.