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The Southern Flames present  Jeff Barber Lottery/Registration Form

 Name:                                                                                                              

Address:                                                                                                          

                                                                                                                       

Telephone:                                                                                                       

Alternate Telephone (mobile):                                                                           

Email Address:                                                                                                 

 

Jeff Barber Satake Class Preference (only check one):

 

              Only able to attend October 23-24, 2008 (Thursday/Friday)

 

              Only able to attend October 25-26, 2008 (Saturday/Sunday)

 

              Can attend either session, prefer Thursday/Friday -You may be placed in either class.

 

              Can attend either session, prefer Saturday/Sunday – You may be placed in either class

 

                    Do you want to be on the waiting list if your name is not drawn for a class session (circle one)?  yes    no

 

Please print out, complete, then mail the completed form and your check in the amount of $275.00 (Members) or $295 ( Non Members) made payable to “Southern Flames” to:

Southern Flames

c/o Martha Fuerst

2679 Mercedes Drive NE

Atlanta, Georgia 30345-3974

 

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For Southern Flames Administrative Use Only

Received On _________   Check # __________

 

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