REGISTRATION FORM---PRINT CLEARLY!!!!
Course Name:__________________________________________
Course Date:___________________________________________
Course Location:________________________________________
How did you hear about us?_______________________________
Participants Name:_______________________________________
Address:_______________________________________________
City:______________________Postal Code:__________________
Telephone #:_____________Birthdate: Month___Day___Year_____
Sponsor or Employer:_____________________________________
Mailing Address:_________________________________________
Postal Code:________________Phone#______________________
..............................(to track your ticket if lost)
Please check method of payment
CASH___CHEQUE____CHARGE____MASTERCARD____VISA_____
Form date: Jan 26,2005