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You
may register by Name_______________________________________________________________________ Address_____________________________________________________________________ City/State/Zip________________________________________________________________ Phone
(day)____________________________
Email__________________________________ Parent/Guardian
Name if participant is under 18: List
Classes/Workshops below. In needed, use separate paper for additional
classes. Cancellations-If
it’s necessary to cancel classes, the DCA will refund payment.
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Class |
Fee |
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Total
fees |
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Payment: |
Check
#______ |
Cash |
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Visa/Mastercard |
Charge
Card Number________________________________________
Expiration_________ |
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Cardholder
Signature
__________________________________________________________________________ |
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