Student's Name:

Address:       City:       Postal Code:

Home Phone:       Cell Phone:      
Email:

Please specify any medical conditions:

In Case of Emergency contact:     
Home Phone:      Work Phone:

I am sending payment by cheque (mail to: Bonnie McLean 2781 Bank Road, Kamloops, BC, V2B 6Y5)  

I will bring cash to Bonnie PRIOR to the workshop  

Conditions:

• NO Cancellations after June 24, 2015
• Workshop subject to sufficient enrollment in which case registrant will be refunded.