WORKSHOP/CLASSES REGISTRATION FORM
Seeds for Change Wellness
105 Oak Drive Sellersville, PA 18960
email: seedsforchange@comcast.net
website: www.seedsforchangewellness.com
Phone:
(Susan Anderson) 267-377-0088
(Scott Anderson) 267-218-1027
Workshop/ Class Registration
Name: ______________________________________ Date: _____________________
Address:
____________________________________ ______________________ ____________
(Street) (Town) (Zip Code)
Telephone: ___________________________ email address: _______________________
Registration for:
Workshop/Class Title: Halloween Ceramics Class
Workshop Costs: Check which applies...you may sign up for a single week or both weeks
____ Week 1: $ 17.00 pumpkin & painting fee
____ Week 2: $ 5.00 painting fee
_____ Total
Date: October 15 & 22 Time: 7:00 PM - 9:00 PM
Please Make Check Payable to: Andrea Linaberry
Mail Completed Registration to the Above Address
Registration is Confirmed Upon Receipt of Payment