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CAPITAL SYMPOSIUMS Registration Form for March 23rd, 2007
Return your completed form and payment to: Capital Symposiums c/o Jill Grassmick , P.O. Box 746, Luray, VA 22835
Due to limited seating in most continuing education presentations, early registration is HIGHLY recommended. DCDHA reserves the right to substitute speakers/courses due to unforeseen circumstances.
Return your completed form and payment to: Capital Symposiums c/o Jill Grassmick , P.O. Box 746 Luray, VA 22835
*PLEASE PRINT*
NAME:__________________________________ DH License #or ADHA#___________
ADDRESS:_______________________________________________________________
CITY, ST, ZIP:____________________________________________________________
Phone #_______________________________(H)_____________________________(W)
E-mail Address:________________________________________________________________
Indicate Course Date(s):___________________________________________________
ADHA member ADHA member $ 95
Non-member $ 130
Student Fee $ 25
Check all that apply:
_____ ADHA member _____ Non-Member
_____ SADAH member _____ Non-SADHA member
Make checks payable to: “Capital Symposiums”.
Mail to: Capital Symposiums c/o Jill Grassmick
P.O. Box 746
Luray, VA 22835
QUESTIONS?
For registration info: For general info:
Jill Grassmick Pat Shand
jgrassmick@starband.net kwpat@cox.net
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