Western National Roundup 2017

QUICK FORM

This form is available for agents, leaders, advisors, and/or persons filling out the main registration form to give out to those wanting to attend. (NOTE: Do not mail this form to the Western National Roundup – it is to be returned to the person registering the group – Registration must be completed on-line to be valid!)

Name: ______County: ______M/F: ______

Address: ______

City:______State:______Zip:______

Date of Birth: ______

Phone: ______Work Phone: ______Cell Phone: ______

FAX: ______Email: ______

Participation type - Roundup Delegate, Chaperon, or Guest; Consumer Decisions Contestant, Coach, Chaperon or Guest; FCS Presentations Contestant, Coach, Chaperon or Guest; Fashion Review Contestant, Coach, Chaperon or Guest; FCS Bowl Contestant, Coach, Chaperon or Guest; FCS Skill-A-Thon Contestant, Coach, Chaperon or Guest; Livestock Quiz Bowl Contestant, Alternate, Coach, Chaperon or Guest; Livestock Contestant, Alternate, Coach, Chaperon or Guest; Meats Contestant, Alternate, Coach, Chaperon or Guest; Hippology Contestant, Alternate, Coach, Chaperon or Guest; Horse Bowl Contestant, Coach, Chaperon or Guest; Horse Demo Individual, Team, Coach, Chaperon or Guest; Horse Public Speaking Contestant, Coach, Chaperon or Guest; Horse Judging Contestant, Alternate, Coach, Chaperon or Guest; Prepared Speech Contestant, Coach, Chaperon or Guest; Impromptu Speech Contestant, Coach, Chaperon or Guest; Parliamentary Procedure Contestant, Coach, Chaperon or Guest

Participation type:

Speech or demonstration title: ______

Package information – Please Circle One

(A) $400.00: Required for All Youth Contestants and Roundup Delegates

(B) $350.00: Coaches, Parents and Guests (does not include a lunch)

(C) $50.00: Awards Breakfasts (Sat or Sun) Only

(D) $250.00: Meats/Livestock participants Only

Tour choice: _____ A – Colorado Springs $90.00

_____ B – Greeley $90.00

_____ C – Ski Trip: (Additional Information Needed)

Meal choice: ___Vegetarian Special Request: ______

(There is a possibility we will serve both beef and chicken. So if you have an allergy to one, please list it in the Special Request area.)