John Wise Balloon Society
JohnWise.net
Safety Seminar On-Line Registration
Saturday, March 6, 2010
Millersville University -
You may place your registration now for our ONE DAY seminar:
1-- by filling in this form,
2-- submitting it on-line,
3-- and mailing your check including all applicable fees to the address below.
4-- Deadline for submitting this form is February 25. Registration after that date will be at door.
First Name: *
Last Name: *
Street: *
City: * State: * Zip: *
Email Address:
Phone: *
Pilot/Crew Rating: *
BFA Member?: BFA Membership Number:

Do you need Wings Credit:


If you are sending Seminar payment to cover your crew/pilots, please list names here:
-2nd attendee
Name(First, Last): BFA#:
---Street: City: State: Zip:

-3rd attendee
Name(First, Last): BFA#:
--- Street: City: State: Zip:

-4th attendee
Name(First, Last):
--- Street: City: State: Zip:
* indicates required entry
A check in the amount of $* will be mailed within two days of today. See rates listed below.
Make checks payable to John Wise Balloon Society or JWBS
and mail to JWBS c/o Larry Swistoski
8 Wagner Street, East
Hummelstown, PA. 17036 tbd
for questions, email Larry Swistoski its4853@hotmail.com or call 717-566-8309

By hitting the 'Submit Registration' button, this form will be emailed to Larry.
or
Registration Fee: Includes year 2010 John Wise Society dues

CREW -- $40.00 prepaid or $50.00 at the door.
PILOTS-- $60.00 prepaid or $70.00 at the door. Commerical, Private or Student License.


return to Seminar page.