Name:__________________________________________________________

Address:________________________________________________________

City:_____________________________ State:_____  Zip:________________

Email:__________________________________________________________

Phone:____________________________________

Complete this form and return it with a $25/one day, or $50/two days
non-refundable deposit to reserve a seat, with the balance due prior to the
workshop date.  
Reservation deadline is Feb. 16, with the balance due March 2, 2019.

Make the checks payable to CPSA DC 117.
Mail registration and check to:
         
         Judy Madigan
         7 Franciscan Lane
         Palm Coast FL  32137

(Sorry no credit cards accepted).
Barabara Dahlstedt CPSA, CPX  Workshops Registration

$80/day members, $95/day non-members
Deposit - $25.00  (non-refundable) due with registration Feb 16, 2019
Balance - $55/day members, $70/day non-members due March 2, 2019

Saturday & Sunday, March 16 & 17, 2019  - 9 AM to 4 PM