Personal Information

Name 1
Name 2
Name 3
Name 4
Phone
E-mail
Credit Card Number (VISA, MASTERCARD or DISCOVER) NO AMEX!
Expiration Date
CCV Three Digit Security Code on Back of Card

Event Information (check all applicable boxes)

Coffee and Snacks at 8:30am, Seminar begins at 9am Lunch Provided

Number of Adults 1 $40.00 2 $80.00 3 $120.00 4 $160.00 Number of Adults attending $40 each (15 and up)

Number of Kids 14 and under 1 $10.00 2 $20.00 3 $30.00 4 $40.00 5 $50.00 6 $60.00 $10 for attendees under 15

Reserve your spot by March 5th