Registration Form

REGISTRATION FORM

INSTRUCTIONS:

To avoid Late/Onsite Fee, registration must be received seven days in advance of the workshop
Complete the registration form below, print and mail with payment to:

Mark Grevelding/Fit Motivation
619 Fairmount Ave
Rochester, NY 14626
markgrev@aol.com

First Name
Last Name
Address 1
Address 2
City
State
Zip
Email
Telephone


Workshop

Method of Payment:	Check Visa Mastercard

(Please make checks payable to Fit Motivation)

Amount Enclosed:
Credit Card Number
Expiration Date	MM YY
Name on Card
Signature

Comments or Special Instructions