2009 Steam School Registration Form

Name

Name on Badge

Name on Certificate

Street Address

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

E-mail Phone No.

                    E-mail will be sent to confirm registration

Number of years operating engines

What do you expect to get out of this class?

Do you plan on camping?   Yes  No

Do you plan on having the Saturday night catered meal (optional) for $10.00?   Yes  No

Please make checks payable to the Wisconsin Historical Steam Engine Association Inc. (WHSEA)

Forward your $50 class fee, meal money, if applicable, and registration form to:

Jeff Bloemers

W4597 County Rd. F

Waldo, WI 53093