LEARNING AT HOME REGISTRATION FORM
Postmarked one week in advance of the workshop date.


Name(s):_________________________________________________________

Address:_________________________________________________________

_________________________________________________________________

Name(s) of your teen(s) who will be attendiing with you (age 13 and older) #____

_______________________________________________________________


Phone number:____________________________________________________

Email address:____________________________________________________

Name of workshop _________________________________________________

Date of workshop: _________________________________________________

Location of workshop:_______________________________________________

Single Registration: $43
Married Couple Registration: $53

_____ Check if your teenager will also be attending (free of charge) 


Amount enclosed: ___________

Make check payable to Barbara Mesh and mail to:

Marcy Schaller
P.O. Box 150188
Cape Coral, FL  33914

Remember to bring a 3 ring binder in which to place your Resource Packet.