Wagon Wheel Ranch Registration Form

Wagon Wheel Ranch Registration Form

Future Reflections Winter/Spring 1998, Vol. 17 No. 1

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Registration for 1998 Kids' Trip
Wagon Wheel Ranch

Child(ren) Name(s)/Age(s)

Parent/Guardian

Phone ( )

Address

City State Zip

Amount Enclosed $

(Make check payable to NOPBC.)

The following registered child is blind or

visually impaired:____________________ If you have registered a child with special needs,

please list name of child and needs.

Mail with payment to:

Carla McQuillan, NFB of Oregon

5005 Main Street

Springfield, OR 97478

Questions? Call Mrs. McQuillan at: (541) 726-6924