Course Registration Form

1) Read everything on the Getting You Going on Your Season page.

2-a) Type in your information in the boxes provided below. Then print.

(Make sure all typed-in information is visible! At this point I have not been able to

figure out how to get the "tick boxes" (that you would put a check in) to work right, they were printing

out as just black squares. So after you print out this page, please put a checkmark in the

circle beside the ones you intend to check. I'm sorry for the inconvenience,

but have not been able to figure out what the problem is.)

~OR~

2-b) Print out this page and then fill in the information by hand.

4) Send the completed form along with the $15 registration fee to us at:

Dave and Barb Shelton / 182 No. Columbia Hts. Rd. / Longview, WA 98632

:::::::REGISTRANT INFORMATION:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

Name:
Address:
City: State Zip
E-Mail Address: Phone:

(See note in 2-a above about checking boxes!!!!!)

О I am registering for the Foundational Portion of the Course (required for ALL, no matter what the children's ages) as well as for the: (Check one or both:)

О Younger Child Portion of the Course (for parents with children age 12 and under)

О Older Child Portion of the Course (for parents with children age 12 and older)

(So if you have a child age 12, you need both portions.)

:::::::CERTIFICATE OF COMPLETION INFORMATION:::::::::::::::::::::::::::::::::::::::::::::

(The names of both husband and wife may go on the one certificate IF both have done all the reading of and listening to the resources, and both have processed and read all the responses in the Course Syllabus. In other words, one spouse may do all the writing in the syllabus, but for both the husband and wife's names to go on the Certificate of Completion, BOTH must have done ALL the reading and listening, and then read through and discussed the DFF's together.

Name(s) to go on Certificate of Completion:

Please print clearly so that I will not make any errors on your certificate!

:::::::ENROLLMENT & PAYMENT INFORMATION::::::::::::::::::::::::::::::::::::::::::::::::::::

I am enrolling for the course, called the "Season of Re-education & Renewing of the Mind," and I understand that, to be enrolled in the course, I will need to select (and AM selecting) one of the following two options:

О I have enclosed a check or money order (U.S. funds only) for $15 for the Course Enrollment Fee. (non-refundable)

(If you live outside the U.S., you'll need to pay by credit card as we are no longer able to accept foreign checks or money orders,

unless you are willing to pay the additional $10 fee that the bank imposes on us. Yes, even if your bank is in U.S. funds)

О I have paid this fee via Barb's website

I understand that, to be considered "enrolled in the course," I also need to purchase the Course Syllabus. I'm doing that by:

О I have already purchased it at Barb's website (Please purchase before sending in this form to us.) ...OR...

О I am enclosing a check for $7.00 + $3.00 S/H (+ 53 cents in WA only, for TAX) (Again...)

(...If you live outside the U.S., you'll need to pay by credit card as we are no longer able to accept foreign checks or money orders,

unless you are willing to pay the additional $10 fee that the bank imposes on us. Yes, even if your bank is in U.S. funds)

:::::::CERTIFICATE OF PARTICIPATION INFO [OPTIONAL!]::::::::::::::::::::::::::::::::::::::
О I do NOT need a "Certificate of Participation."

О I DO need a "Certificate of Participation" (to send to a school district as proof you are taking a course ~ which I would NOT recommend you do unless specifically asked to by them.) I have enclosed $3 extra for this extra service.

:::::::COMMENTS OR QUESTIONS????????::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

Comments or Questions for Barb:

:::::::PAYMENT INFORMATION:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

I have already taken care of payment at your online catalog.

I am enclosing $__________. Make check or money order payable to: Dave Shelton.

NOTE: IF YOU LIVE OUTSIDE THE U.S.: You will need to pay by credit card as we are no longer able to accept foreign checks or money orders, unless you are willing to pay the additional $10 fee that the bank imposes on us. Yes, even if your bank is in U.S. funds. Isn't that crazy?!?! But we have no say in the matter. Wish we did!)