This form will hold your place for 7 days from the date of receipt. Your reservation will be confirmed upon receipt of your check or money order. To pay with a credit card, click here to use our secure PayPal option - do not provide credit card information on this form, as we cannot guarantee the security of an e-mail.

Please make checks payable to DOUGLAS W KINNAIRD, and mail to:

PLEASE REGISTER ME FOR -

WORKSHOP: ON DATE:

NAME:

ADDRESS:

CITY STATE ZIP

PHONE FAX

E-MAIL