2011 WABC Rob and Kathy McKay Teacher Training Workshop Registration by Credit Card

Payment Information:

First and Last Name on card     

Participant's Total USD $

Master Card or Visa Card: type 4 numbers then a -, 4 times for a total of 16 numbers (example:1234-5678-1234-5678)

Expiration date: 2 digit month/2 digit year       3 digit Security Code on back of card 
 

for United States card holders only (required for processing)  zip code used for card statements  

By completing this registration form and filling in date below you agree to the following waiver and release:

The undersigned agrees to defend, pay and save free and harmless Lifestyle swim school, Inc., the facility owners where lessons are conducted and their respective agents, employees' actions, judgments and proceedings of any kind or in favor of anyone whomsoever and from and against all injury or property damage arising directly or indirectly out of, from or on account of applicant's presence at or use of the facilities or participation in any activities or programs applied for hereby or at any time hereafter. 

Date:

Contact Information:

First and last name  

Street, city, state, zip  

Email:   Website

Home telephone (including area codes)    Cell Phone 

Occupation   Employer

Tell us about yourself. Teaching background etc.

Second participant Contact Information:

First and last name  

Street, city, state, zip  

Email:   Website

Home telephone (including area codes)    Cell Phone 

Occupation   Employer  

Tell us about yourself. Teaching background etc.

If there are questions about your registration you will be contacted prior to processing.

Questions: Email   mckayswim@aol.com or phone: 1-561-393-6386

Workshop Refund/Cancellation Policy
Registrants unable to attend will receive a refund of paid registration fee, less a USD $50 processing charge per full workshop registration...If email or phone notice is received no later than Wednesday, September 16, 2011.  No refunds given after September 16. Substitutions may be made for participants unable to attend in lieu of refund/cancellation after September 16.