The Club 4 Me Seminar Registration Form Payment Methods The price of The Club 4 Me seminar (5 workshops) is $200.00. Address personal checks to Karien Bennett. You may also send payment via PayPal. Directions Please print this form and fill out completely; attach payment (unless paying via PayPal; in this case provide some verification of payment) and send to this address: Karien Bennett 1125 Loma Ave #119 Coronado, CA 92118 Additional Questions If you have any questions, call Karien at 619-307-9015. You may also e-mail her at club@theclub4me.com. Student Name: _________________________________________________________ Parent Name: __________________________________________________________ Street Address: ______________________________________________________ City: ________________________ State: ___________ Zip: ________________ Age: ___________ Grade: ________________ Phone Number: (___________) _____________ - ____________________________ Parent Cell: (___________) _____________ - ____________________________ Student Cell: (___________) _____________ - ____________________________ E-mail Address: ___________________ @ ___________________________________ How did you hear about us? _______________________________________________