2005 (Saturday & Sunday) Two-day Weekend Seminar Series Sponsored by Natural Anglers & Captain Barry Kanavy - 516.785.7171 Please print and mail completed registration form to: Natural Anglers, 3944 Beacon Road, Seaford, NY 11783. Date: ______________________________________________________ Name: ______________________________________________________ Mailing Address: ______________________________________________________ City/State/Zip: ______________________________________________________ Phone: ______________________________________________________ Fax: ______________________________________________________ Email: ______________________________________________________

Tuition for Two-day Seminar for ____ person(s) @ $750.00 per person = $___________ The cost for the Two-day Seminar is $750.00 (per person), which includes: - Friday & Saturday evening receptions with the instructors - All instruction and classes during two full days of school - The use of our equipment for casting and all training aids - Lunch on Saturday & Sunday The cost of the school does not include lodging and there is no fishing during the school. We have guides available for two days after the school. You must coordinate your own fishing and lodging partners for double occupancy. Guided Fishing Charter after school: 1 or 2 Anglers Per Boat @ $575.00 per day times ____ day(s) = $___________ Total Amount Due = $___________ Enclosed is my 50% deposit in the amount of $___________ paid by: Check______ Visa______ MasterCard______ Account #______________________ Expiration Date ___/___/____ Exact Name on the credit card ______________________________ Your signature ______________________________ Release of Liability, Payment Authorization & Cancellation Policy I authorize Natural Anglers to charge the deposit amount to my credit card according to the information stated on the above page and I agree and authorize the charge of the balance due 15 days prior to the event. If I made the deposit by check, I understand that the balance is due 15 days prior to the event. A refund of $575.00 will be due to me for each full day of guided fishing cancelled due to the weather. The refund will be given in the same method as it was paid. Deposit refunds may be made up to 15 days before the trip for a cancellation charge of $100.00. I further agree to accept responsibility and assume any and all of the inherent risks, which may arise from my participation in this excursion. I accept responsibility for risks that may cause illness, injury, death or inconveniences. I am aware that saltwater fly fishing, boating and travel related to this excursion may expose me to travel delays and physical accidents. In consideration of and as part payment for the right to participate in this excursion and related activities, I agree to release and discharge Natural Anglers, it's officers, directors, employees, instructors, guides chartered, agents and Barry Kanavy from responsibility for any damages or injuries that may occur as a result of my participation in this excursion. I have carefully read this Release of Liability, Payment Authorization & Cancellation Policy and fully understand and accept its conditions. Agreed to by: __________________________ Date: ___/___/____ Please send the completed form to: Natural Anglers, 3944 Beacon Road, Seaford, NY 11783. Please make check payable to Natural Anglers.