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Name: ____________________________________
Address: ___________________________________
City: ___________________________
State: _______________ Zip: ______________
Phone: ________________ (Day) (Eve)__________________
E-Mail: __________________________________
Payment
$25.00 non-refundable deposit due by Feb. 9th Final pmt. Due Mar. 2nd 2002
Amount Paid ____________ Number Attending________
(Please send name and address for each additional person)
Print out form, mail and make checks payable to:
Christian Women's Seminars
P.O. Box 201
Burlington, NJ 08016
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