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

Name _____________________________________________________

Name of your teen(s) who will be attending with you [Saturday only] (age 13 and older) #_____

___________________________________________________________________

 

Address: ___________________________________________________________

___________________________________________________________________

Telephone Number: __________________________________________________               

E-mail Address: _____________________________________________________

 
To reserve my seat for the above workshop(s), enclosed please find a check* in the amount of:

 (Please circle all that apply.)

Friday Single $25      Friday Couple $30     Saturday Single $43      Saturday Couple $53 

                                                                                                                                           Total__________

 

*Make check payable to Barbara Mesh and mail to:

Stephanie Hart, 412 Anderson Dr. Auburndale, FL  33823