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Fast Start Registration

Date of Leadership School: July 10, 2004
Deadline for Registration: July 2, 2004

Make Payment out to: Francisco Dillon

Send Payment to : Myrli Dillon

75 New Brunswick Ave.
Suite A 2nd Fl.

Hopelawn, NJ 08861

	Money Orders and Bank Checks Only. Any Personal Checks will be sent back.
	Tickets will be mailed to the address provided upon receiving the payment.
	If any tags are lost or left behind, please provide the confirmation letter as proof of payment.
	Children must be with their parents at all times due to insurance liabilities.

Name:
Address:
Phone:
Email:
Regional Vice President:
Hierarchy:
*note: please correctly indicate the hierarchy in which you are in so that a confirmation may be sent to the correct location.
Number of Tickets:	Number of Tickets: Name Required For Each Ticket
Payment must be received no later than 2 weeks upon registration. A confirmation will be mailed upon receiving payment. If you register and do not send payment, then registration is invalid.