The Encouragement Zone Registration Form

A non-refundable $100 deposit is required to register. Balance is due at the beginning of class.

 

To pay with PayPal, click the button and fill in class description and cost on the PayPal form.  A convenience fee will be added.  Email this completed form to  tkottman@cfu.net

A place in the class is not held until this form is received!

NAME(s):

ADDRESS (please include street, city, state, and zipcode):

PHONE:

EMAIL:

Course

 Title:

Course Start Date:

AMOUNT ENCLOSED:

   Check paid to :             ----------------        Paid with

   Terry Kottman         circle payment method    PayPal

To pay by check, print this form and mail, with deposit, to:


Terry Kottman

PO Box 1045

Cedar Falls, IA 50613


Please make check payable to Terry Kottman

Class Deposit

$100.00

$4 use fee added

Other Amt Class Payments

$20 use fee added

PLEASE - email completed registration form at time of Paypal deposit to reserve spot