Registration Form for Zoe Jakes
Please use this form to register for the Saturday seminar with Zoe
___Saturday Seminar---10-3 p.m.---$65 before 11/23/07 ___Saturday Seminar---10-3 p.m.--$75 after 11/23/07 _____Saturday Show 8 p.m. $10
**Registration fees are non-refundable unless the event is cancelled **
Total:______________
Please mail completed form with your check or money order to:
Jennifer Dawson
4753 Wicklow Drive
Middletown, Ohio 45042
Please print all information carefully:
Name:_________________________________________________________________________________________________
Address:________________________________________________________________________________________________
_______________________________________________________________________________________________________
Phone:_____________________________________________Email:_________________________________________________
I hereby release and hold harmless Denise Miller, Jennifer Dawson, Zoe Jakes, Caravan Workshops, Road Apple Music, City of Middletown, staff and assistants of this event from any and all claims for injuries or loss which I may sustain while participating at my own risk in any and all parts of activities connected with this event.
Legal Signature and date
______________________________________________________________________________________________________