Amount enclosed @ $200.00 per person $____________
Space is limited!
Payment in full must accompany registration no later than July 15th.
mail to:
Pat Still
122 West 74th Street Apt B
New York, NY 10023
Name:________________________________________________________________
Address:______________________________________________________________
City/State/Zip:_________________________________________________________
Phone #:______________________________________________________________
Email:________________________________________________________________
I would like to share a room with:
_____________________________________________________________________
_____________________________________________________________________
Amount enclosed @ $200.00 per person $____________
Space is limited!
Payment in full must accompany registration no later than July 15th.
mail to:
Pat Still
122 West 74th Street Apt B
New York, NY 10023