Eclectic Master Class Registration Form

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Name _____________________________________________________

Address____________________________________________________

City,  State  Zip____________________________________________

Home Phone  __________________             Work Phone __________________

Email Address   ______________________________________________

Workshop Choice

Check only One of the Following 3 day classes for April 23-25, 2004

Aura de’Dragon         ___________

Heartfully Speaking   ___________

Class Payment

1. Deposit required $100.00 Non-refundable

    This holds your seat. The balance is due by March 23, 2004                __________

2.  Balance of class is $275.00 if you wish to pay the full amount

      Please add this to your total by writing it on line 2.                              __________

3. Total of enclosed add line 1 and 2 together                                            __________   

 Mail your total of line 3 to:  

Cyndy’s Dolls, LLC

Dept EMC

P.O. Box 44244

Columbus Ohio 43204