Phone:

Company or Individual responsible for payment:

ConcreteCountertops      Mar 11 - 12, 2009

Mailing Address:

City:

Cell Phone:

Fax:

Company Key Contact:

Email address:

State:

Zip:

PLEASE RESERVE A CLASS SPACE FOR THE FOLLOWING INDIVIDUAL(S):

REGISTRATION REQUEST:

Name #3:

Name #1:

Name #4:

Name #2:

Payment methods: (one choice required)

Arrival: 8:30 AM to 9:00 AM

Class: 9:00 AM to 4:00 PM

Questions - call 636-544-8604 or email concretecenter@gmail.com

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The

       Decorative Concrete Training Center

                                                                    "Inform, Teach, Inspire"

Payment of $450.00 for each attendee will be made day class begins by cash, check, or credit card. I understand no discounts apply.
Contact me to arrange advance payment of only $400.00 for each attendee.  I understand payment must be made before Mar 6, 2009.