2013 Oregon BeaveRG XV
Registration Form
May 10, 11, 12 - 2013
Red Lion Hotel - Convention Center
Portland, Oregon
Print /// Fill-Out For Each Attendee /// Mail.
Name for Badge:  
Name of Member / Attendee:  
City State Zip:  
Is This attendee under age 21? (Y/N) 
Registration fee:       
Before 2013-Feb-28 $60
Before 2013-Apr-15 $70
Thereafter $80
under 18 if accompanied by paying adult $40
Sat. Banquet @ $30$
Sun. Brunch @ $20$
RG T-Shirt @ $15
Please Circle: S   M   L   XL
Total $
Make Checks Payable to:
Oregon Mensa RG
Mail Rgistration Form To:
Stephen Darnell,
3011 NW 23rd Ave.,
Camas, WA 98607-8094.
If paying by credit card, circle:
VISA MasterCard American Express
Name as printed on card:  
Credit card number  
Expiration month / year:  
For Red Lion Hotel reservations, please call 503-235-2100 or toll-free 800-343-1822. Ask for special Oregon Mensa hotel rate: $72.00 plus tax (single, double, triple, quad) available until April 10, 2013. Cancellation deadline for no-charge is "April 15, 2013."

For more RG info, email financialwizard2@comcast.net , or call 360-834-6020. Refund policy: full refund for cancellation notice received by Registrar by April 16. You can find this registration form on-line, and more information, at the Oregon Mensa website: http://www.oregon.us.mensa.org
To get this form to print on a single page, do PRINT PREVIEW and experiement with SHRINK TO FIT (IE) or SCALE (FireFox).