Instructions:
First Name: Last Name:
Address line1:
Address line 2:
City: State: Zip Code:
Phone: -
Please register the following persons for the seminar:
Individual seminar registrations @ $25.00 each = $
List names below:
1. 2.
3. 4.
Couples registrations @ $45.00 per couple = $
List Couples below:
Seniors (60+) @ $20.00 each = $
List Seniors below:
Students @ $20.00 each = $
List Students below:
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