8/12/2019 Aquaponic Class Registration Form

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Aqua Vita Farms

Two Day Aquaponic Training Course

May 31st June 1

st, 201

!egistration Form

In order to guarantee your reservation please fill out all sections below and

mail to: Mark E. Doherty, 1! "arts "ill #er. $hitesboro %&, 1'(!).*lease include a check or money order for the full sum, made payable to

Mark E. Doherty or indicate payment via *ay*al. *lease note the cut off date

for the discount rate is +pril 'th, no registrations will be accepted after May)'rd. If registering multiple participants please use separate forms, however,

one check, money order or *ay*al invoice may be used for payment.

%ame

+ddress

#elephone -

Email

"ow would you like reservation confirmation: *hone Email

Method of *ayment: /heck Money 0rder *ay*al

#2hirt 2i3e: 2 M 4g 5lg )5lg

2ignature6&our signature indicates that you are registering for a two day nonrefundable a7uaponic

training course administered by Mark E. Doherty and +7ua 8ita 9arms /onsulting, 44/