JANUARY ADVENTURE 2008        PROGRAM REGISTRATION FORM

You will have to print this page, fill it out and mail it with a check!

Choose one of the following:            and Check here (   )   if attending Concert Sunday

(   ) Session 1, Friday evening through Sunday noon, January 18-20

(   ) Session 2, Monday evening through Wednesday noon, January 21-23

Last name:______________________First name:_____________________

Last name:______________________First name:_____________________

Address:_______________________________________________________

               _______________________________________________________

City:_______________________State:________Zip:___________________

Telephone:____________________E-address:________________________**

No. Persons_____at $109.00/each $____________(program only, room and meals not incl.)

No. CEUs_______at $10.00/each  $____________for whom___________________________

Total for program and CEUs       $____________

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 2008

                                                415 Magnolia Avenue

                                                St. Simons Island, GA 31522 

Epworth is full - see bottom of the Participate Page for other nearby hotels with negotiated rates

**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

You may cancel anytime before the day your session starts and forfeit $10.00 of each registration fee.