| First Name:
________________
if couple - second name: ________________ |
| Last Name: ________________ |
| Street Address:
_________________________ |
| City:
_____________________ |
| State: _______ |
| ZIP: ________ |
| E-Mail Address:
_________________________ |
| Telephone: (______)
_____________________ |
| Payment Method:
_________________
(Check, 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 mail to:
La
Canada Companies
11258 N. Via Rancho
Naranjo
Oro Valley,
AZ 85737
|
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 |
|
