| First Name:
________________ if couple,
second name: ________________ |
| Last Name:
________________ |
| Street Address:
_________________________ |
| City:
_____________________ |
| State: _______ |
| ZIP: ________ |
| E-Mail Address:
_________________________ |
| Telephone: (______)
_____________________ |
| Payment Method:
_________________
( Visa, MC, Discover) |
| Card No.:
_____________________________ |
| Expiration Date: __________ |
Card Security Code: __________
MC: 3 digits on rear after acct # - Visa: 3
digits on
rear after acct #
|
| How did you learn about the workshop:
_______________________________ |
| _________________________________________________________________ |
Promotional Code:
____________________
|
| Print this form,
complete and fax to: 520-219-3480 |
Thank you for
registering.
|
| Cancellation/Refund
Policy: If cancellation
occurs on or before April 30, 2008, the registration fee is
refundable.
There are no refunds for cancellations after April 30, 2008. |
______________________________
Your Signature |
|