Registration

Name:____________________________________________________________________

Address:__________________________________________________________________

__________________________________________________________________________

Phone: _______________________________

Email Address:________________________

Airport pickup from Charlottesville? ☐ Want carpooling information? ☐

Enclosed is: The deposit only of $50 (balance due by June 1st) ☐

Tuition only of $350 ☐

Room/Board $375 ☐

Room/Board and Tuition of $725 ☐

For those who don’t eat chicken, fish, wheat and dairy, alternatives can be provided

Please list dietary needs ____________________________________________________

_________________________________________________________________________

Print form and mail check payable to:

Jan Baty

807 Kenyon Lane

Newark, Delaware 19711

For questions concerning the workshop or registration,

Registration Form

June 24th-29th, 2012