REGISTRATION FORM

To Register: Please send this form with either your check or money order, or credit card payment info to:
Dave Decker
Merriam Park Professional Building
366 Prior Ave. No., Suite 203
St. Paul, MN 55104

Cancellation Policy: Registrants must notify us at 612-725-8402 48 hours in advance of the first class in order to receive a refund

Name ___________________________________________________

Street address _____________________________________________

City ____________________ State _____ Zip __________

Home phone _______________ Work phone _______________

Workshop Name _____________________________________________________________ Cost $___________*

Presenter: ___________________________________________________________________

[check (X) payment method] Enclosed is my check or money order ( --), or

Paying by Visa ( --), MasterCard ( --), Discover ( --), include: Exp. Date ____________

Card# ______________________________________________

Signature ________________________________________________

* CHECKS SHOULD BE MADE PAYABLE TO: David J. Decker, MA, LP