Name:__________________________________________________________

Address:________________________________________________________

City:_____________________________ State:_____  Zip:________________

Email:__________________________________________________________

Phone:____________________________________

Complete this form  and return it with a $25 non-refundable deposit to reserve a
seat, with the balance due prior to the workshop date.  
Reservation deadline is Feb. 17, with the balance due March 3, 2018.

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).
C.J. Worlein Workshop Registration

$150 members, $175 non-members
Deposit - $25.00  (non-refundable) due with registration Feb 17, 2018
Balance - $125 members, $150 non-members due March 3, 2018

Saturday & Sunday, March 17 & 18, 2018  - 9 AM to 4 PM