STONE CARVING WORKSHOP WITH PARIS ALEXANDER

REGISTRATION FORM

Please send a check (made out to Paris Alexander) and the completed the registration form and mail to Paris Alexander at 201 E. Davie St., Raleigh, NC 27601. Registration will not be confirmed until payment is received. Last day to register is Friday, May 1, 2009.

Name:_____________________________________________________________

Email: ____________________________________________________________

Day Phone: ____________________ Eve. Phone: ________________________

Address: __________________________________________________________

City: ______________________State: ________ Zip: ______________


Emergency Contact : ________________________________________________

__________________________________________________________________

Phone 1: _______________________Phone 2: _______________________


__________________________________________________________________

Waiver of Liability: I hereby release Paris Alexander from any and all liability, cost or expense associated with an injury I  may sustain while participating in the Stone Carving Workshop.

Signature :_______________________________________Date:_______________________


MARK YOUR CALENDARS!
  

                  TOTAL : $325.00

(Please make checks payable to: Paris Alexander) CHECK # :_________