Enrollment Form:
Please copy and paste in your browser and send to ghosttownsafari@charter.net or print and mail with payment to
Make checks and money orders payable to “Tableau’ Vivant”
Robert (Bob) Davis
2415 E. 12th
The Dalles, Oregon 97058
Please, you must read the Responsibility and Release of liability form . . .
your signature and payment signifies that you have read, and, you fully accept the release!
Name:
Address:
City:
State:
Zip Code:
Day Phone:
Evening Phone:
Cell Phone:
E-mail:
Payment Type, circle one . . . Check – Visa – MasterCard – Discover Card – Money order
Card number with expiration date ______ ______ ______ ______ exp. ______
Signature:
Your signature means you have read and accepted the terms of the “Responsibility and Release of Liability!” Click on this link it will take you to the release page.