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| Program Name, Location & Date_____________________________________________________________________ | ||
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| Information: | ||
| Name First______________________________Middle__________________________Last____________________________ |
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| Mailing Address___________________________________________________________________________________ | ||
| City___________________________________________State____________________________Zip_______________ | ||
| Telephone Number________________________________________________Birthday____________/_____/_______ | ||
| E-mail Address____________________________________________________________________________________ | ||
| M/F____________Profession_________________________________________________________________________ | ||
| Please list any food allergies and/or special requirements: | ||
| ________________________________________________________________________________________________ | ||
| ________________________________________________________________________________________________ | ||
| ________________________________________________________________________________________________ | ||
| Cancellations/Refunds Cancellations must be received seven (7) days prior to the start of a program for full refund. Full refunds will be made in the event that the minimum required enrollment of ten (10) participants is not reached. |
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| Signature___________________________________________________________________________ | ||
Please make check payable to Savannah Shaw and mail along with registration form to: Savannah Shaw, 2045 Trowbridge Ct., Charlotte, NC 28270 |
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