regist.htm - REGISTRATION FORM -

REGISTRATION FORM

Please print out & send to:
Sage-femme c/o
P.O. Box 13025
Chicago, IL 60613
or copy and pre-register by e-mail to [email protected] or
Sage-femme
note: space not final until payment received

NAME:_____________
ADDRESS:
CITY: STATE: ZIP: _
PHONE #'S: _
E-MAIL: __________

SPECIAL NEEDS: (we'll do the best we can)
need ride from Chicago
need ride from Milwaukee
need ride from Madison
I plan to arrive from: _
Arrival Time: _
I am renting a car
I can offer a ride
from: ________________

Workshop fee inclosed: $_
Scholarship donation inclosed: $_
TOTAL: $_____

PLEASE INCLUDE PAYMENT WITH REGISTRATION
Upon Registration, address & directions will be sent
Along with phone #'s
Send Check or Money Order to:
P.O. Box 13025
Chicago, IL 60613

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