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 Name:                                                                                                              

Address:                                                                                                          

Telephone:                                                                                                       

Alternate Telephone (mobile):                                                                           

Email Address:                                                                                                 

Pam Dugger Class Preference (only check one):

              Only able to attend February 16 & 17 (Thursday/Friday)

 

 

              Only able to attend February 18 & 19 (Saturday/Sunday)

 

 

              Can attend either session, prefer Thu/Friday – You may be placed in either class.

 

 

              Can attend either session, prefer Sat/Sun – You may be placed in either class.

                    Do you want to be on the waiting list if your name is not drawn for a class session (circle one)?  yes    no

Please print out and complete this form.  You can either drop this form and your check off at the Wednesday, September 21, 2005 Southern Flames meeting, or you can mail the completed form and your check in the amount of $275.00 made payable to “Southern Flames” to:

Southern Flames

311 Peachtree Hills Avenue, Box 11A

Atlanta, GA  30305

NOTE:  Mailed CHECKS AND FORMS MUST BE RECEIVED BY Mon DEC 12, 2005

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