Class/Workshop Registration

Off the Beaten Path    15 Boonton Ave., Butler, NJ 07405    (973) 492-1974

Name
Address
Address
City, ST Zip
Phone

Class/Workshop	Date	Time	Fee
Paid By:    Money Order      Cash    Visa     MasterCard     Discover     American Express		Sub-Total
		Tax
		Total

Card Number ________________________ Expiration Date ________ Signature ________________________________________________

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