Printable Course Registration Form
Print this form and mail, fax, or bring it in personally to:
For The Health Of It, Chef Jennifer Winick,
106 Parsons Street, Easthampton, MA 01027; FAX:(413) 531-6700
Registrant Information
Name: __________________________________
Address: _______________________________
City: _______________ State: ____ Zip: _____
Day phone: _________________________ Evening Phone: ___________________
Email: ___________________________
Course Information
Course Name 1: _____________________________ Start Date: ___________ Cost: ___________
Course Name 2: _____________________________ Start Date: ___________ Cost: ___________
Course Name 3: _____________________________ Start Date: ___________ Cost: ___________
TOTAL: ___________
Payment Information
Payment by check, cash or money order only, payment may be sent with registration, or
made on the day of the course, prior to commencement.
Miscellaneous Information
How did you hear of the us? ____________________________________________________________
Additional comments, questions or pertinent information, Special needs, etc.:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
|
|