To register by Mail, print and mail this form to:

Name: __________________________________________________________

Address: ________________________________________________________

City: ____________________________________ Zip: ____________________

Home Phone: _____________________ Work Phone: ___________________

Email Address: ___________________________________________________

Instructor	Class	Day/Date

Visa and Mastercard are Accepted:

Name as it appears on card (please print) ____________________________________

Account Number______________________________ Expiration Date______________