Registration Information and Class Fee

*First Name: *Last Name:

Address/Apt#:

*City/State:

*Home Phone: Work Phone:

*Age: Male: Female: Seniors(45+) $25 - Adults $50

DON'T FORGET!      May 3, 10, 17, & 24,  2003

Instructor:  Stan Brown from The Media Store, Inc. Seattle, WA.

*Required Information

List any other classes you'd like to take in the future.