Javier Antar Workshop Registration Form

Name:     ________________________________

Address: ________________________________

City, St. ZIP:  _____________________________

Email:    _________________________________

M&M’s Whole Shebang ____________________

A la carte:

# of classes: ________

And if you KNOW which ones, please let us know)

____________________    _____________________

____________________   _____________________

____________________.

Are you a leader or a follower?  _________________
Am interested in either:  ______________

Form of Payment: (please circle)
Including a check
Paid via Paypal/the web
Will pay cash at the door

Please make checks payable to Laura Pellegrino 

Mail checks to:  
Laura Pellegrino 
5803 Shoal Creek. Blvd., 
Austin, Tx. 78757

Email to bsasbaby (at) gmail.com when completed.