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Registration Form

Please return by November 15, 2006, with registration fee.
Name(s):____________________________
Adress:_____________________________
City:_______________________________
Zip:________________________________
Phone:______________________________
*Email:______________________________
* e-mail addresses will only be used for class purposes and not given to anyone else
Location I plan to attend
_____  Columbia _____ Glasgow
_____  Sedalia  
Class Fee $60/individual $75/couple
If the class fee presents a significant financial barrier to your participation please contact Mary Sobba (573) 581-3231 or e-mail: sobbam@missouri.edu
Make Check Payable to:University Extension
For all locations, return this form, with payment to
Audrain Extension Center
101 N. Jefferson St., Rm 304
Mexico, MO 65265

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