2010 Student Handbook

Name:

Gender :

Business Name:

Mailing Address:

City:

State:

Zip Code:

Business Phone:

Home Phone:

Fax Number:

E- Mail:

PPA # For Merits:

If your first choice is filled, you will automatically be enrolled into the class of
your second choice. Your name will be placed on a waiting list
for your first choice, in case of cancellation.

Classes May 3 - 7, 2010

Instructors

Don Chick- $595.00
Scott Dupras- $625.00
Wayne Miller- $495.00
Mary & Shawn Mortensen- $595.00
Neil van Niekerk- Full

2010 Student Handbook

First Choice:

Second Choice:

Class Materials - Session One:

Please enter session total here: $

Scholarship from:

Scholarship Amount:

All Meals & Multiple Occupancy Dorm Room:

Total Amount Due: $

If you wish to room with specific people; register at the same time and list the roommates.
If you do not list roommates; roommates will be assigned.

Roommate # 1

Roommate # 2

Roommate # 3

Roommate # 4

Contact Registar: Phil Ziesemer, 1200 E 7th Street, Merrill, WI 54452
Phone 715 536 4540
CONTACT: HELEN KOLPITCKE 715 842 5946