Registration form

Name: _________________________________________________________

Business: ______________________________________________________

Description of workshop: ___________________________________________

________________ _____________________________________________

Address: _______________________________________________________

City: ___________________________________________________________

Postal Code: ________________ Fax Number: ________________________

Phone (Business) ______________________Cell #:_____________________

Email address: ____________________Web-site: ______________________

 

Method of payment accepted:
Cheques payable to Nance MacLeod, Visa, MC, accepted

Card #: _____________________________Expiry Date:_________________

Signature: ______________________________________________________