MAIL OR FAX
REGISTRTAION IS CLOSED
WALK INs ONLY AND SUBJECT TO SPACE
AVAILABILITY
BRING A CHECK FOR $275 PAYABLE to the ELIJA FOUNDATION
or pay at the door with visa or mastercard
REGISTRATION FORM FOR Two Day Wrightslaw Boot Camp , Presented by Pete Wright, Esq. November 13-14 2009
Marriott Residence Inn 9
Gerhard Rd Plainview NY
_____ Number of non
refundable Registration(s)@ $275 for both days
(includes lite breakfast & boxed lunch, those with dietary restrictions are encouraged to bring their own lunch )
THOSE WITH DIETARY RESTRICTIONS ARE KINDLY ASKED TO BRING THEIR OWN LUNCH.
***Consider your cancelled check as your confirmation, $75.00 cancellation/bounced check fee
Total amount enclosed $________
Name (s) _______________________
_______________________________
_______________________________
Address _________________________
_______________________________
Phone ______________________ Email_______________________
Organization or Affiliation (ie: Parent,Speech,Teacher)_____________________
Send Check or Money Order Payable to:
The Elija Foundation
665 Newbridge Road Levittown NY 11756
We also take Visa/Mastercard (circle one) Acct#____________________________ Exp Date:________
Card Holders Signature: _____________________________
