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REGISTRATION FORM FOR WORKSHOPS




Your name: _______________________________________________________Degrees____________________

Address:  _________________________________________________________________________     

_________________________________________________________________________________

________________________________________________   Postal code: _____________________


Telephones:  cell______________________;  home: ______________________  wk: ____________________

Email address: _______________________________________________________________________________________

Website? : ______________________________________________________________________



I am enrolling in the workshop titlled: __________________________________________________________ 

held in  __________________________________________________________________________________.


I have the following dietary requests: __________________________________________________________________________________________

______________________________________________________________________________________________________


I am especially attracted to the workshop for the following reasons and training requests:

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

I am especially interested in focus on training about (be specific):

___________________________________________________________________________________________

I have enclosed the minimum registration fee ___________________ made payable to Ann E. Hale  with (for deposit only) written on the back.

To be mailed to Ann Hale, 353 Highland Ave, No. 2, Roanoke, VA 24016  Any contract or directions will be mailed with the acknowledgment of your reservation

Telephone inquiries: Ann Hale (540) 400-8182 

Additional comments and requests:




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Author: admin - Published on: 2009-03-08 (1524 reads)

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