Registration form

Please make all checks out to SETT and mail to:

MARY JANE TODD SEMINAR

c/o Frankie Conar

168 Mulberry Lane NE

Cleveland, TN 37312

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NAME: _____________________________________________________________________

ADDRESS: __________________________________________________________________

CITY:__________________________ STATE:____________________ ZIP: _____________

PHONE NUMBER:__________________________ CELL:__________________________

I will be attending FRIDAY: _________________ SATURDAY: _______________

I wish to purchase the surface for FRIDAY (ROOSTER) $29.50:_____________

SATURDAY (JOHNNY APPLESEED) $36.50:_____________

Included with this registration form is my total payment of: $___________