Use your computer's print command to print out a "faxable" copy of this form.

Program / Workshop / Drumming Event:
Place:
Date & Time:
Cost:
Facilitator: Jack Barnes

Please complete the following:
All information provided will be kept in strictest confidence.

Name:
School Board / Other Affiliation:
Address:
City / Town:
Province:
Postal Code:
Phone:
Fax:
E-Mail:

Fax this form to : (519) 631-4819 or mail to the address above.
You will be contacted as soon as possible to confirm your registration.

RETURN TO DRUMANTICKS