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Please sign me up for the August 6-8
Silent Weekend

Name_______________________  F____  M____

Name you'd like on badge:_________________

I'd like to room w/__________________________

_________________________________________

Address______________________________

City_________________ St_____  Zip________

Day (____)__________ Eve/cell (___)___________

Email:___________________________

Level: __Beg.  __Interm.  __Adv. __Terp  __Deaf

I have read & understand the cancellation policy.

______________________      ____________                        Signature                                Date

Mail checks payable to Sign Language Factory.                                        
Mail Registration Form with payment to:
Sign Language Factory
292 N. Wilshire Ave.
Suite 101
Anaheim, CA 92801

CC #_________________________ Exp. date_______

Name on Card_________________  code on back_____

___Visa  ___Mastercard   Amount of payment _________

Signature_________________________

Office Use Only                                                                                    Date rec'd _______  Ck #_________ cc___  Amount_______

 
 
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