Registration Form

For Barb Shelton's

Conference in Anaheim, California ~ Orange County

March 19~20, 2004

DIRECTIONS:

1)  Click to "Full Screen"

and then print out this form.

2)  Fill in this form by hand.

(Yes, the old fashioned way! Weird, huh?!?)

(Do NOT try to type it in here; I don't have it set up to work that way.)

3)  EITHER:

A - Write out a check or money order for the

correct amount, payable to Joshua School, or...

B - Write your credit card info at the bottom

of this form.

4)  Mail the completed form to:

    (with payment if paying

    by check or m.o.) to:

Name of Mom: ____________________________________________________________

My  [ husband / teen ]    [ __will   __will not ]  be attending with me on  Friday night.

My  [ husband / teen ]    [ __will   __will not ]  be attending with me on  Saturday.

  (Neither husbands nor teens have to pay, but we do need to know how many to set up for)

___ I have read  Barb's Policy on children at her meetings  and, whether I agree or not (and it's OK if I don't), I will comply.    (nicely  ;-) )

Address: ________________________________________________________________________

City/State/Zip: ____________________________________________________________________

Phone Number:  __________ -- __________ -- ___________________    

Email Address: _____________________________

Website Address? ________________________________________________________________

INDIVIDUALS:

___ I am signing up before the Early Bird deadline of Feb. 7, so I am paying $30.00 and understand that I will receive (at the conference) a free tape from Barb.

___ I am signing up Feb. 8 or after, so I am paying the regular fee of $30.00, and understand I will NOT receive a free tape (much as I would have liked to have had one and wish I'd signed up earlier!)

GROUPS:

___ I am signing up WITH MY GROUP before the Early Bird deadline of Feb. 7, so I am paying $25.00/person (not group) and understand that I will receive (at the conference) a free tape from Barb.

___ I am signing up WITH MY GROUP Feb. 8 or after, so I am paying the group fee of $25.00/person, and understand I will NOT receive a free tape (much as I would have liked to have had one and wish I'd signed up earlier!)

TOTAL AMOUNT DUE: __________

(ALL payments for everyone in a group must be enclosed.)

___Enclosed is a check or money order.  (U.S. funds only, please.)

___Please charge to my credit card.   (Info must be provided below.)

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Credit Card Information

(*'d items indicate information we must have to process your order)

*Name on card: ___________________________________________________________

*Address of card holder:      __ Same as above        __ Different:

            ______________________________________________________________________

City/State/Zip:  ________________________________________________________________

Phone Number (if different from above):  __________ -- __________ -- ___________________  

Email Address (if different from above):  ___________________________________________  

(If this is included, you will be sent an e-notification upon processing of your payment.)

*Card Type:     __ MasterCard        __ Visa       __ Discover       __ American Express 

*Card Number:  __________  __________  __________  __________       *Exp. Date:  ____/____

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www.homeschooloasis.com