We will contact you at the phone number provided to confirm your registration. If there is a specific time that you wish to be contacted, please note that information in the Comments/Notes field.

Required fields are in bold.

Class registering for:	10/16/2010 and 10/17/2010
Registration Type:	Individual - $195 Couple - $265
Name:
Spouse:
Email Address:
Address:
City:
State/Province:	(please select) AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolionaNorth DakotaNebreaskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhone IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNova ScotiaNorthwest TerritoryOntarioPrince Edward IslandQuebecSaskatchewanYukon
Postal Code:
Daytime Telephone Number:
Comments/Notes: