Skillshop Registration Form

Thank you for your interest in attending a S.E.E. Skillshop. To reserve your seat, please fill out the information below.

Please register me for the: *

First Name *

Last Name *

Street Address *

City *

State *

Postal Code *

Home or Cell Phone *

Work Phone (P.O. contact):

Email Address *

I am a *

Other:

Years Signing: *

Sign Language Mode Used: *

Have you attended a prior SEE Skillshop? *

Yes

No

Prior Skillshop Location:

Year(s) Attended:

Prior Skillshop workbook was:

Ended at lesson number:

My instructor for that Skillshop was:

Skillshop Fees (please select one):

	-
Weeklong Early Registration ($350)	-
Weeklong Registration ($385)	-
Weekend Early Registration ($175)	-
Weekend Registration ($200)	-
Nebraska Early Registration + Meals ($200)	-
Nebraska Weekend Registration + Meals ($225)	-

Total Fees: *

Full payment for all sessions is due at the time of registration. A fee may be charged for no-shows or if you cancel less than 7 days prior to the event date.

I am paying by:

Credit Card Number:

Expiration Date (mm/yyyy):

Name on Credit Card:

Credit Card Billing Address:

When using an Institutional Purchase Order, a hard copy of the PO must accompany the Registration and must be for the full amount of registration. Please print this form and either Email, FAX or mail the completed form with the PO to:

S.E.E. Center for the Advancement of Deaf Children
PO Box 1181
Los Alamitos, CA 90720-1181

FAX: (562) 795-6614

seecenter@seecenter.org