JANUARY ADVENTURE 2009 PROGRAM REGISTRATION FORM
You will have to print this page, fill it out and mail it with a check!
Choose one of the following:
( ) Session 1, Friday evening through Sunday noon, January 16-18, 2009
( ) Session 2, Monday evening through Wednesday noon, January 19-21, 2009
Please use a separate form for each different last name!!!!!
Last name:______________________________First name:_____________________
Last name:______________________________First name:_____________________
Last name:______________________________First name:_____________________
Last name:______________________________First name:_____________________
Address:_______________________________________________________
_______________________________________________________
City:_______________________State:________Zip:___________________
Telephone:______________________E-address:________________________________**
1 person $109 2 persons $218 3 persons $327 4 persons $436
No. Persons_____at $109.00/each $____________ PROGRAM only (room and meals not incl.)
PLEASE ENCLOSE TOTAL PAYMENT WITH THIS FORM.
Make check payable to January Adventure, Check No._______Amount:______________
(Sorry, January Adventure does not have the capability to process credit cards.)
Send this form with your check to: JANUARY ADVENTURE 2009
415 Magnolia Avenue
St. Simons Island, GA 31522
see bottom of the Participate Page for links to room & board providers
**Print legibly, we need to be able to decipher your e-address.
We will acknowledge Program Registrations by e-mail if you provide an e-mail address. Please
configure your computer to receive e-mail from buzpic@bellsouth.net and Januaryadventure@bellsouth.net
You may cancel anytime before January 15, 2009 and forfeit $25.00 of each registration fee.
CEUs NOT available this year
PLEASE PUT YOUR REQUESTED DATES ON YOUR CALENDAR, LEST YOU FORGET!