NAME:

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COMPANION (If Applicable):

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ADDRESS:

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CITY:                               STATE:                 ZIP:

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HOME PHONE:

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WORK PHONE:

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E-MAIL:

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EMERGENCY CONTACT:

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NON-REFUNDABLE DEPOSIT (For Each Weeks Stay):

Prospector package $250.00

The Gold Miner package $350.00

Bring Your Own Equipment Package $200.00


INDICATE THE WEEK(S) YOU PREFER TO PROSPECT:

June 13 - June 19		July 18 – July 24
June 20 - June 26		July 25 – July 31
June 27 - July 3		August 1 – August 7
July 4 – July 10		August 8 – August 14
July 5 – July 11		August 15 – August 21
July 11 – July 17

Please Mail this registration page along with deposit to:

Goldfever Prospecting W2579 Hidden Lane Seymour, WI 54165 Phone: 920-366-0430 Fax: 920-833-2346 Goldfev@aol.com

After May 1st Gold Fever Prospecting Dean Race 77.5 Taylor Hwy Chicken, AK 99732

After your reservation is confirmed and prior to departure, you will be asked to sign a waiver releasing Goldfever Prospecting of any responsibility.