Registration form 2009
Name
____________________________ Address __________________________
Phone H _________________________ Phone W _________________________
Phone
C__________________________ Email ____________________________
$100 Workshop Fee
$15 CE Processing fee.
Lic: # ________________________
Check # ________ Payable to Rev. Tracy L. Parker
Visa Mastercard
________________ญญญ____ ____________
Credit Card Number Expiration Date
Please mail completed form, payment to:
Rev. Tracy L.
Parker
55
Sierra Madre,
CA. 91024
Refund Policy: 90% up
to one week before class.