Weekend Workshop Registration

    Workshop Dates:
    Name:
    Street Address:
    City:
    State: Zip Code:
    Daytime Phone:
    Evening Phone:
    Cell Phone:
    Your Email Address:
    Status:
    Best Number To Call:
    Name to be used for name tag:

    Partner's Name:
    Partner's Address:
    Partner's City:
    State: Zip Code:
    Partner's Daytime Phone:
    Partner's Evening Phone:
    Partner's Cell Phone:
    Partner's Email Address:
    Partner's Best Number To Call:
    Name to be used for name tag:

    Method of Payment:
    Credit Card No.:
    Expiration Date:
    How did you hear of us?:
    Referred by:

    Cost & Confirmation:
    $ 400 deposit is due with this registration to guarantee your space.  The $400 balance is due (and will be charged) one week prior to the workshop.

    Payment by Check:
    If you are paying by check: In order to guarantee your space we must receive your check in the amount of $400 within five (5) business day of receipt of this registration.  The remaining $400 is due one week prior to the workshop.  Complete this form, print and mail with checks payable to: Michael Borash.  Click here for mailing address.