Film+Seminar+Sign-up+Form

=Film Seminar Sign-up Form= (to print this form click on the ... button in the top right, and choose print from the menu)

Name:
 * >>>>>>> Registrant 1

Email"

Phone: || Fee (Donation $10 pp/ps)

Amount $ ..................... ||

>>>>>>> Registrant 2 Name:

Email:

Phone: ||

Fee (Donation $10 pp/ps)

Amount $...................... ||



Additional Donation to the Silvia Miller Fund (if desired).... ||

Amount $......................... ||

TOTAL ||

Amount $.......................... || Date:...................................................

Have you ever been in one of Jim's film seminars before? Yes:.........; No...........

Signature:.....................................................

Please mail the completed form, with your check, to Osher Lifelong Learning Institute at UCSC STARS, 1156 High Street Santa Cruz, CA 95064

And remember to send an email to Robert Franson, UCSC_LLL@baymoon.com, to confirm your registration.