Teacher training in Boca Raton, Florida

Payment Information:

First Name on card        

Last Name  on card   

Participant's Total USD $

Master Card or Visa Card Number

 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  

Dates of workshop

Contact Information:

Organization/Company Name  

Website

Participants name 

Address  

City

State (US)       Region    Province

Country   

Postal Code (in US zip code)     

Email address confirmation & workshop communication will come to you by email  

Telephone including area code    Cell Phone 

Other special requirements, questions or assistance needed

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

Questions: Email   mckayswim@aol.com or phone: 1-561-362-5490