LEARNING AT HOME REGISTRATION FORM
Postmarked one week in advance of the workshop
Name of Teen:_________________________________________________________
Name of Teen:_________________________________________________________
Name of Parent:_________________________________________________________
Address:_______________________________________________________
_______________________________________________________________
Phone number:__________________________________________________
Email address of Parent:__________________________________________________
Date of workshop: _______________
Location of workshop:_______________________________
Each Teen Registration is $20. Each teen must attend with a parent or be registered with another adult.
Parents attend free of charge.
Amount enclosed: ___________
Make check payable to Barbara Mesh and mail to:
Barbara Mesh
2030 Capps Road
Lake Wales, FL 33898