Name

Address

City

State / US Territory / Military State
Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Island Palau Puerto Rico Virgin Islands Armed Forces Africa Armed Forces Americas (except Canada) Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific

Zip

Email Address

Phone

Name of child care/preschool/organization you are associated with

Name of class/workshop you are registering for

Location

Date Time

How did you hear about us? Signing Time Website
Internet Search (which search engine)
Friend (friend's name)
Print ad On line ad (web site)
Other (please specify)

Have you taken any of our courses before? Yes No
If yes, which one(s)?

May we add you to our email list to be notified of upcoming classes & events Yes (be sure to enter your email address above) No

Would you like to receive our online newsletter? Yes No

I have read and agree to the policies and procedures as set forth in Itty-Bitty Signers' Class and Workshop Participation Agreement and understand and agree to the refund policy set forth therein.

Class/Workshop Tuition: $

Total Submitted: $