REGISTRATION FORM
Registration prior to the date class begins is mandatory.
Class fees are listed under each class/workshop description.
 

WOODBURY YOGA CENTER

UNION CONGREGATIONAL
CHURCH

WATERBURY HOSPITAL

TIME EXPO CENTER

Name:

__________________________________

Address:

__________________________________

City/State/Zip:

__________________________________

Home Phone:

__________________________________

Work Phone:

__________________________________

Class Title:

__________________________________

Class Dates:

__________________________________

Class Time:

__________________________________

Comments:

__________________________________

__________________________________

Credit Card Type:

MC Visa (circle one)   Exp. Date: ________

Card Number:

_______________________________________

Name on card:

__________________________________

VERY IMPORTANT! Did you check one of the class location boxes above?