Workshop Registration

Participant #1 Information

Please fill in all fields that apply. Fields marked with * are required.

*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State/Province:
*Zip/Postal Code:
Country:
Home Phone #:
*Preferred ContactPhone #:
*E-mail:
*Name of Workshop:
*Date of Workshop:
*Price:
	I would like to be emailed a PayPal invoice.
	I would like to mail a check.

Comments:
 

Participant #2 Information

Please fill in all fields that apply.

First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Preferred Contact Phone#:
E-mail:
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Thank you! 

I look forward to working together. 

With gratitude and appreciation,