THE COUNTRY JUNCTION

Country Living Clinics Registration

April 25 & 26, 2009

Name    Age

Address

City State    Zip

Phone   Cell #   Email 

 List any experience that you have had and what you hope to learn from the clinic

Please indicate which clinic/clinics you will be taking.   (one class per day)

To reserve your spot in the clinic. Please complete this registration form, Print 2 copies,  (one for your records)  return the other one with  registration fee ($65.00 a class per person)  to 

THE COUNTRY JUNCTION ~ 2400 Garner Rd ~ Alvaton Ga. 30218. 

(dead-line for registration is April 18, 2009)

Signature ___________________________________________________   Date 02/13/2009 01:57 AM 

(Parent or Guardian if under 18)

If you have any questions please email us at sandy@thecountrypark.com or call  (706) 538-1062 or cell phone (770) 328-5742

Submit for pre registration (will not be registered until we receive payment)

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