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Information |
| Name |
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| Address |
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| City, State,
ZIP |
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| Phone |
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| Email address |
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| Name, as you want on Name
Tag |
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| Credit Card Type |
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Credit card number and
expiration date
and security number on back of card |
CC #
exp date
three digit security number:
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| Name as it
appears on card |
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Click
your Workshop Selection and Credit Card Authorization
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Shadowcliff Workshop
- Deposit
Friday, January 2, 2009, to January 4,
2009
(see "Workshops" for details.
Facilitator: Jim Crabtree
Deposit $200 |
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Shadowcliff Workshop
- Remainder
Friday, January 2, 2009, to
January 4, 2009
(see "Workshops" for details.
Facilitator: Jim Crabtree
Balance additional to deposit: $250 |
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Shadowcliff Workshop
- Total
Friday, January 2, 2009, to
January 4, 2009
(see "Workshops" for details.
Facilitator: Jim Crabtree
Total Deposit and Remainder at once: $450 |
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| I authorize you to charge
my credit card for the amounts I have selected. |
Yes:
No:
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