Name:

Address:

City:   State:     Zip:

Phone:    

Email:

RWA Number (if applicable):     

Signature (type in):

My signature above constitutes acceptance that admission to the workshop depends on receipt of this form and payment fee before the cut-off date for the workshop. If the form and payment is received AFTER the cut-off date, the payment fee will be returned.

Once your online form is submitted, you will receive a link to direct you to Paypal.  Upon receipt of your payment and registration form, you will receive an email confirmation that you have been registered for the workshop.  If you do not receive a confirmation email within a week of registering, please contact Patti Shenberger at pattishenberger@comcast.net

Note: print this application for your records before submitting