|
Grand Master George Dillman
REGISTRATION FORM
HANDS ON SEMINARS
ALWAYS THE FIRST SATURDAY IN AUGUST
Children-11-12:30/$40 $50/AFTER July
Adults- 1- 4/$80 $90/AFTER July
Instructors bring 5 students pay $40
Instructors bring 10 students you go FREE
Print And Return To 32 Park Ave. Bay Shore, NY 11706
NAME________________________________________
ADDRESS_____________________________________
CITY______________ STATE_____ ZIP____________
PHONE #______________________________________
E-MAIL_______________________________________
INSTRUCTOR_________________________________
SCHOOL NAME________________________________
AMEX VISA MASTERCARD
ACCOUNT #___________________________________
PAYMENT AMOUNT___________________________
SIGNATURE___________________________________
CHECK#__________
MONEY ORDER#_________
