MinnBlast'10 Registration Form

Our server stopped supporting our Registration Form (so 'submit' button at bottom of page doesn't work)

New instructions:

1) Fill Form

2) Copy the page

3) Paste it in an email to:jack@elorantaassoc.com

Name:
E-mail Address:
Mailing Address:
City:
State:	MN AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Other
Zip Code:
Phone:

	Before March 15th	After March 15th	Sub Totals:
S&T Day (Thurs)	$150.00	$175.00
Level One ISEE(Wed)	$175.00	$185.00
Level Two-Construction (Wed)	$95.00	$110.00
Level Two- Quarry (Wed)	$95.00	$110.00
Wall Control/Overbreak (Wed)	$45.00	$60.00
Spouse	$50.00	$60.00
Booth	$300.00	$350.00
Booth (sponsor rate)	$100.00	$150.00
Reception(Wed. eve)		included with course or S&T registration
Extra Tickets to Reception	$20.00	$25.00
Join Lake Superior Chapter	$20.00	$20.00
Hazmat Training – Explosive Identification (Wed)	$35	$45
Speaker	$0
Student Rates S&T Day (Thurs)	$50.00	$60.00
Level One ISEE (Wed)	$125.00	$150.00
Level Two-Quarry(Wed)	$35.00	$45.00
Reception(Wed. eve)	included with course or S&T registration
Wall Control/Overbreak (Wed)	$10.00	$20.00
Level Two-Construction (Wed)	$35.00	$45.00
PLEASE ENTER TOTAL: