Rebuilding Seminar Registration Form

To register, complete this form and return it with a $35 non-refundable deposit to:
Rebuilding Seminars
 3192 Breeze Dr.
Sun Prairie, WI 53590
(make checks payable to Rebuilding)

 
Name:_____________________________________________________________________
Home Address:______________________________________________________________
City/State/Zip:_______________________________________________________________
Home Telephone:____________________ Work Telephone:___________________
Cycle (check one): ____Fall ____Winter ____Spring ____Summer
Please check one:    ____Male      ____Female
Please check one:    ____Early Bird Fee $225 (Postmarked two weeks prior to opening night)
                                  ____Regular Fee $250
I prefer (If no preference, leave blank.):   ____Mon. class      ____Wed. class   
(Summer class is Monday only)
Class size is limited.  If there is enough demand, a second session will be added on Wednesday nights, except summer.