CONTINUING EDUCATION
PRE-REGISTRATION FORM
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Be advised that seating is limited, a tuition deposit
of \$20 will reserve your seat in class.
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NAME:__________________________________________________________

ADDRESS:______________________________________________________

CITY:____________________     STATE:________      ZIP CODE:___________

PHONE:_________________________________________________________

DEPOSIT_______________________________      & nbsp; CHECK #:_____________

Please detach and remit to:
Walter King
95 Monroe Road
Quincy, MA 02169

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Last Modified:  August 2011

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