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NAME
1 or 2 people?
ADDRESS
PHONE WORK
HOME NUMBER
DATES OF Internnship (Sunday to Sunday)
CREDIT CARD NUMBER
EXPIRATION DATE

The seminar must be paid for in full. Your lodging can be guaranteed with a credit card, payable in cash, or credit card on arrival. Should you want to pay for lodging by check, your check should arrive three weeks before your class. Checks should be made payable to Barbara Notarius.

BARBARA NOTARIUS
49 VAN WYCK ST.
CROTON-ON-HUDSON, NY 10520