Print Out This Registration Form and Mail To:
Comadres Institute
P.O. Box 420180
Summerland Key, FL 33042
Include Check or Money Order Made out
to Marina Alzugaray
or Submit Credit Card Info, thank you.
Registration Contact Information:
Name______________________________________________________________
Address____________________________________________________________
City State Zip________________________________________________________
Phone_____________________________________________________________
Email______________________________________________________________
Please Register Me for:
Program____________________________________________________________
Date of program______________________________________________________
Program Fee _$______________ CEU Fee_$___________ Total _$_____________
Credit Card Payment Information: (Visa, MasterCard, American Express, Discover)
Credit Card # _______________________________________________________
Expiration Date______________________________________________________
Signature__________________________________________________________
Additional Comments: