Dorothy Lesher's Starlight Waltz - Mail-in Registration

Note: You can print this registration form in most browsers by selecting Print from the File menu.

ANG Number:
First Name: Last Name:
Address:
Apartment Number: (if applicable):
City:
State (or Province):
Zip (or Postal) Code: Country:
Home Phone: Work Phone:
e-Mail Address:


_________ Instruction Booklet and Kit

Payment Amount:

U.S. Members

______ Class fees, course booklet, complete kit, and postage: $175.50

Canadian Members

______ Class fees, course booklet, complete kit, and postage: $193.00

International Members

______ Class fees, course booklet, complete kit, and postage: $211.00

Payment Method:

_______ Check (enclosed with this form)

_______ Charge my credit card

MasterCard or Visa (circle one)

Number: ________________________________________

Expiration Date: __________________________________

Signature:_______________________________________

Mail the completed registration form and your payment to:
ANG CyberWorkshop
2424 American Lane
Madison, WI 53704-3102
Fax: 608-443-2474