Registration Form

Name: __________________________ Address: ________________________________

Phone: ______________ Amount enclosed: __________ Today's date: ______________

Class Title: __________________ Date: ______ Time: _____ Fee you are paying: _____

Class Title: __________________ Date: ______ Time: _____ Fee you are paying: _____

Payment Check/Visa/Master Card/Discover # __________________________________

EXP DATE: _____________ Signature:________________________________________