register me NOW!

You have chosen to pay by check or money order to register.  Please fill out the form below, so that we know to account for you in the course and to watch for your payment. Mail your payment to:

                                           ATTENTION: Sue Nordemo
                                           3 Grimsby Lane
                                           Nashua, NH 03063

Enclosed is the amount of $
I am paying with
Name of Class
Month
Date
Name
Street Address
City, State & Zip Code
Home Telephone
Work Telephone
Fax Number
Email Address
First Name or nickname for name badge
Full Name for Certification
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