Preserve @ Home
Registration Form
Payment _____________
Date __________________
Check # ______________
Please pre-register by calling the OSU Extension Service/Tillamook County office to reserve your
space. Then bring or mail this Registration Form and the $50.00 class fee to OSU Extension
Service/ Tillamook County, 2204 Fourth Street, Tillamook, OR 97141, make checks payable to
OSU Extension Service. Class size is limited. The following information is required for course
registration. Please fill out all information and return to the address in lower right corner with
the course fee.
Name
Email
Address
Phone
Birth date
(mm/dd/yy)
Course materials released Thursday, January 14. The chat is scheduled for Thursdays,
starting on January 21st at 1:00 pm PST
--------------------------------------------------------------------------------------------------------------------Enrollment Deadline: January 8, 2016
6-Week Class Starts on: January 14, 2016
Course fee: $50 plus cost of required supplemental
materials. Make checks out to OSU Extension Service. Send
check with registration.
Lab: The hands-on lab – February 27, 2016 – is at
OSU/Tillamook County office in Tillamook. Lab contact:
Nancy Kershaw, 503-842-3433.
Send registration & payment to:
OSU/Tillamook County Extension
2204 Fourth Street
Tillamook, OR 97141
503-842-3433
Nancy.kershaw@oregonstate.edu
The University of Idaho and Oregon State University provide equal opportunity in education and employment on the basis or race, color, religion, national
origin, gender, age, disability, or status as a Vietnam-era veteran, as required by state and federal laws.