DCA Class & Workshop Registration Form
You may register by 1) Mailing this form, along with payment to: DCA/20904 Northline Rd./Taylor, MI 48180; 2) Phone 734-287-6103; 3) In person, during office hours W-F, 10 am-4 pm.
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. Refunds-No refund after first class for classes.
Workshop refunds must be requested no later than one week prior to the workshop.
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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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