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Registration Form

The document contains a registration form for Group Mentoring & Design classes with fields for contact information, payment details, and terms and conditions. It requests the registrant's name, email, address, phone numbers, class details, payment method, and signature to enroll in and agree to the program's terms.

Uploaded by

Anonymous NnYlEd
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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50 views1 page

Registration Form

The document contains a registration form for Group Mentoring & Design classes with fields for contact information, payment details, and terms and conditions. It requests the registrant's name, email, address, phone numbers, class details, payment method, and signature to enroll in and agree to the program's terms.

Uploaded by

Anonymous NnYlEd
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Group Mentoring & Design

REGISTRATION

[email protected] - 619-990-03350 - 2538 Hartford St. San Diego, CA 92110


Staff Use Only Date:
Received
Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Time:

Referred by:

Item

Class Date

Notes:

Qty Unit Price

Amount

Subtotal:
Coupon:
Shipping:

GRAND
TOTAL:
Name & Mailing address (please Print Clearly):
LAST Name:

ur information is private and will NEVER be sold!


FIRST Name
Please check here if you are between
the ages of 12-17 (under 12 not
permitted inside any event

E-mail Address:
Address:
City:

State:

Zip:

Home Phone:
VISA

Cell Phone:

Work Phone:
CHECK *Make Payable to

MC

DISCOVER
AMEX

Credit Card Number:


Full Name on Card:

MONEY ORDER

CASH

Darin Hunt check#_________

Exp. Date:

CVC:

Phone Number of Cardholder:

Cardholder's Billing Address:


City:

State:

Zip:

Authorized Signature:
By enrolling in this program, you automatically agree to and are bound by the Terms and Conditions provided.

Please Sign:

Date:

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