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Print this form off and mail it in with your check.
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Please make checks out
to: Brenda Messling
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| Continuing Education
Class Application |
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| Date:______-______-______ |
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Name____________________________________
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Address_________________________________________________
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| City______________________________________ |
State__________ |
Zip___________ |
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Home Phone #__________________________
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email address_______________________________
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| Cell or work phone
_____________________ |
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Class applied for #1________________________________________
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cost $_________.00 |
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Class Date _________________________________
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Class applied for #2_________________________________________
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cost
$________.00 |
| Class Date _________________________________ |
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Class applied for #3_________________________________________
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| Class Date _________________________________ |
cost $_______.00 |
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Total |
$________.00 |
| Confirmation of your registration will be sent
to you by email or card after I've received payment. |
