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The MindFood Learning Exchange
Registration Form
Name_____________________________________VIP#_____________________
Occupation________________________________Email______________________
Address_____________________________________________________________
City_______________________________State___________Zip________________
DayPhone__________________________NightPhone_________________________
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Course Date |
Fee |
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MindFood VIP
Membership $29/ $49 for 2 Years |
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Materials Fee is
Paid Directly to instructor at Time of first
class TOTAL |
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I hereby authorize the
use of my MasterCard or Visa:
Signature____________________________________________
CreditCard#_________________________________Pin#________________
(
3-digit code on back of card)
Name on Credit
Card________________________________
Expiration Date/
Month_______________ Yr__________
MindFood Learning
Exchange Mail To:PO Box 42414
Baltimore,Md 21284
Tel: 410-435-0256 Fax:
410-510-1489
WWW.MindFood.Net
Info@mindFood.net |
