REGISTRATION FORM

Name (Membership)_____________________________________

Address:_______________________________________________

City/State/Zip Code:______________________________________

Telephone:_________________Fax:_________________________

E-mail:___________________________________

Early Registration (by Jan. 6, 2010)

Member:   $  125.00     Spouse:     $75.00

REGISTRATION AFTER JANUARY 6, 2010 AND ON SITE

Member:    $ 150.00     Spouse:      $100.00

 Nonmember:  $ 280.00

Registration fee     $______________________

For:____________________________________________

       ____________________________________________

       ____________________________________________

 Mail to:  IWRA

              5213 Lake Washburn Road NE,   Outing,  MN  56662

 Registration fee includes Hospitality Room on Feb. 3 and  banquet dinner on February 4^th.