Print out, complete, and mail, with payment (if applicable) to address below:
Please register the following individual(s) for:
Workshop Name: _______________________________________________________
Workshop Date(s): ______________________________________________________
Workshop Times: _______________________________________________________
Workshop Cost: ________________________________________________________
Name: ______________________________________ Phone: ___________________
Email: ____________________________________________________________
Address: __________________________________________________________
City: _____________________________________ State/ZIP: _________________
How did you hear about MERCY? _______________________________________
____ Check is enclosed, payable to MERCY.
Mail completed form, with payment (if applicable), to:
David and Penny Hudson
MERCY
c/o 505 Wood Springs Road
La Grange, KY 40031

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