CSAMA Safari Pre-Registration Form

CSAMA Safari pre-registration form

Please put only your own personal information in the contact fields (name, telephone and email).

If you must fill out this form for someone else, put their information in the "Comments" section only.

If you leave this page without successfully submitting, you will lose what you have entered into the form.

If you cannot successfully register using this page, please call Bob Farwell at: (816) 246-4517.

Astronomy safaris only call: (913)-515-6421

 

*Name of the safari you plan to attend :    
*First name:    
*Last name:    
Organization:    
State:    
*Telephone:    
*E-mail:    
*Number of adults:     - - Attending the safari
*Number of children:     - - Attending the safari

 

 

Comments & questions:
See note below SUBMIT button.

   

* = Asterisk denotes Required fields.

   

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** Note re. "Questions/Comments" field: If you plan to bring a cell phone, insert "cell: (xxx) xxx-xxxx." We'll use these to help locate our "lost sheep." If other families plan to join you, please have each family fill out a separate sign-up so we can provide a packet of safari information for each family. If it is a group outing and you prefer to enroll all attendees, please list them in the "Questions/Comments" field.
Example:
Smith, Sam & Judy + 3 kids
Jones,
Bill & Sally + 9 kids
1st Presbyterian Youth Group: Name1, Name2, etc.

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