Rocky Mountain Round-Up 2008
Application Form

First Name: Last Name:

Preferred Name on Tag:

Position:

College:

College Street Address:

Additional Street Information(if needed):

City:

State:

Zip:

Office Phone:

Fax:

Email:

Home Street Address:

Additional Street Information(if needed):

City:

State:

Zip:

Home Phone:

Make checks to San Juan College and specify "Rocky Mountain Round-Up"

I will mail the total seminar fee of $395

Submit this form to reserve a slot, then mail your check to:

Mike Tacha
Vice President for Learning
San Juan College
4601 College Blvd.
Farmington, NM 87402-4699
Ph: 505-566-3213
Fax: 505-566-3521
Email: tacham@sanjuancollege.edu

Don't forget to reserve lodging ASAP!
1-888-525-1787, Group DC1SJC