Registration/Order Form

This form may be duplicated

Phone Orders and Inquiries:

Toll-Free (888) 463-4668 (414) 355-8744

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Courses

Course Number	Date	Tuition
		$
		$
		$

Discounts (One Only) Individuals submitting proof of undergraduate student status may reduce their tuition payment by 10% OR groups of 3 simultaneous registration may reduce their tuition by 10%.	Subtotal	$
	Less Discount	$
	Total Registration	$

Books and Video

ID#	Title	Price	Quantity	Amount
				$
				$
				$
				$
				$

Make Checks Payable to: Boehme Workshops 8642 N. 66th Street, Milwaukee, WI 53223 Phone Orders and Inquiries: (888) 463-4668 Fax: (414) 355-6837 Website: www.boehmeworkshops.com	Subtotal	$
	Shipping is 10% of total sales with a minimum of $4 and maximum of $6	$
	WI Residents Only 5% Tax	$
	Book Total	$
	Grand Total	$

Credit Card:        American Express       Discover       MasterCard       Visa
Account #:	Exp. Date (month/year):
Signature:
Name (please print):
Address (Home address is preferrable for course registration):
City:	State:              ZIP:
Home Phone:	Business Phone:
Profession (OP, PT, SP):	Fax:
Email: