Portland Parks & Recreation
REGISTER NOW - ONE OF FIVE WAYS •On-line at www.PortlandParks.org. Click on the Activities tab, then select Registration. We’re sorry,
you may only register for AIR classes on-line. For AIR outings, please register by phone 503-823-4328, fax 503-823-4329 or at the AIR office. •PHONE - Call us at 503-823-4328. Complete this registration form and phone in your registration during open hours: Monday-Friday, 9am - 5pm. Phone in registration is accepted with Visa or Mastercard only. •MAIL - Mail in your completed registration form to AIR, 426 NE 12 Ave., Portland, OR 97232. Include full payment using your Visa, Mastercard or check payable to the City of Portland. •FAX - Call 503-823-4329. Complete the registration form and fax it to us with full payment using your Visa or Mastercard. Fax is accepted 24 hours a day, seven days a week, but is processed during regular business hours. •IN PERSON - Any PP&R facility is able to process your registration, including the Customer Service Center located on the first floor of the Portland Building at 1120 SW 5th Ave. Our office is located at 426 NE 12th Ave. and is open for walk-in registration from 9am - 5pm, Monday-Friday. Call the AIR office first to make sure there is space in the activity in which you want to register - 503-823-4328 V/TTY. CHECK ONE:
New Customer Taken class with PP&R before My account information has changed
Main Contact Name___________________________________________ Birthdate_______________ Male___ Female___ Home Address___________________________________________________ City/ST/Zip____________________________ Home Phone (_____)_________________________________ Work Phone (_____)__________________________________ Cell Phone (_____)_____________________________ Email Address: ____________________________________________ Emergency Contact Name and Phone Number ______________________________________________________________ Will you be using a wheelchair or other adaptive equipment on AIR activities? ____Yes ____No Will you need 1:1 assistance on activities? ____Yes ____No Which activities? ________________________________ Will you be bringing a person to assist you? ____Yes ____No Which activities? ________________________________ PARTICIPANT INFORMATION Name (last, first)
Class Title
Course #
Cost
Non-residents of the City of Portland pay a 30% surcharge. Or you may purchase a Non-resident pass at the amounts listed on page 14. I already have a NR pass. Kind of pass___________________ Purchase date ___/___/___ Passholder name ____________________________________________________________ I need a pass. Circle one: 3 mo. / 6 mo. / 9 mo. / 1 yr. Circle one: Individual / Family Name of person(s) needing pass________________________________________________ I do not want a pass. I choose to pay the 30% surcharge.
Total
Resident____ Non-resident____
PAYMENT INFORMATION
CHECK
Check number___________________ Make checks payable to the City of Portland.
CREDIT CARD Information: VISA Account # __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expires __________________ Mastercard Cardholder’s Name________________________________________ Signature__________________________________________________ Please print
Register On-Line at www.PortlandParks.org 15