2010 Workshop
Registration Form
First Name Last Name
Address City State Zip
Phone E-mail
Emergency Contact Phone
I am registering for:
Date:
AUDITORS:
The
audit fee is $10 per day. Please fill out and return registration.
No
deposit required.
In the event we must cancel, I need to be able to reach you too!
Enclosed is my
non-refundable deposit of $25.00
to reserve my place.
The balance will be paid upon arrival of the clinic.
In the event the event is cancelled, you may apply the deposit to another
event.
Signature Date
* Please return to address above *