COURSE NAME:____________________________________________________________

COURSE DATE:____________________________________________________________

COURSE LOCATION:________________________________________________________

HOW DID YOU HEAR ABOUT US:_____________________________________________

PARTICIPANT’S NAME:______________________________________________________

ADDRESS:_________________________________________________________________

CITY:___________________________________POSTAL CODE:_____________________

TELEPHONE#:________________________BIRTH DATE:(M)______(D)______(YR)_____
____________________________________(to track your ticket if lost)___________________

SPONSOR OR
EMPLOYER:________________________________________________________________

MAILING ADDRESS:_________________________________________________________

POSTAL CODE:______________________TELEPHONE #:___________________________

PLEASE CHECK METHOD OF PAYMENT

CASH_____CHEQUE____CHARGE____MASTERCARD____VISA____

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