Registration Form

For Barb Shelton's Seminars

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 or...

B - Write your credit card info at the

bottom of this form.

4)  Mail the completed form (with payment if

paying by check or m.o.) to:

Name of Mom: ____________________________________________________________

Address: ________________________________________________________________________

City/State/Zip: ____________________________________________________________________

Phone Number:  __________ -- __________ -- ___________________    

Email Address: _____________________________

Website Address? ________________________________________________________________

___ I am signing up as the primary attender and am paying $15.00.

___ I am signing up my spouse for an additional $5.00.

___ of us will attend Friday Night;   ___ of us will attend Saturday

A total of ___ of us will be eating lunch on Saturday.      

___ 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 (still) comply.    (nicely )

TOTAL AMOUNT ENCLOSED: __________

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

Please make out checks to: Canyon Ridge Christian Church

___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:  ____/____

You are at:

www.homeschooloasis.com