Wufoo

Workshop Registration 1/24/09

Saturday, January 24th, 2009 10 a.m.- 1:00 p.m.

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone (Preferred) * ### - ### - ####
Phone (Alternate) ### - ### - ####
Email *
I heard about the workshop: *

From a friend. Please include your friend's name.
Email notification from a listserve. Which one?
From a flyer or card. Where did you see it?
From the Takoma Voice?
From the Gazette newspaper?
Cost Per Ticket: *
Registration with payment received by 1/19/09: $40 Registration with payment received after 1/19/09: $45 Bring your "buddies" - two or more: $40 each. Pre-registration recommended (save time).
I'm bringing a friend (IMPORTANT: each person should register separately). My friend's name is:
Number of tickets
*
Total Price * $ Dollars . Cents
Do Not Fill This Out