LEARNING AT HOME WORKSHOP REGISTRATION FORM
Postmarked one week prior to the event.

Name:_________________________________________________________

Address:_______________________________________________________

______________________________________________________________

If applicable, number of Teens Attending: _____

Names _________________________________________________________
 
          _________________________________________________________

Phone number:___________________________________________________

Email address:____________________________________________________

Name of workshop ________________________________________________

Date of workshop: ________________________________________________

Location of workshop:_____________________________________________

Amount enclosed: ___________

Make check payable to Barbara Mesh and mail to:
Barbara Mesh
2030 Capps Road, 
Lake Wales, FL 33898