Please fill all entries marked with (_*). If you prefer to print out the registration form and mail/fax form, click here.

Date:   *           

Student Info_____________________________________________

First name:  *    Middle Initial (optional)
Last Name:  *

Address (Line 1): *
Address (Line 2):
City: *   State: * 
Zip code: *

Phone: * ext.
Fax:
Email: *

Organization:

Payment ________________________________________________

Select Payment method: check visa mastercard american express *

* Checks are payable to: "The Neve Group, LTD."

Credit card number:
Expiration date (mm/yyyy):
 

Classes_________________________________________________

Schedule

Initial Student                        Additional Student

Course ***	Date 1	Date 2**
DacEasy (all levels)

** Please indicate first and second choice.

***All courses listed in the options menu are at the going rate of $250/initial student, and $240 additional student. 

 

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