Name:____________________________________________________________________________
Address:__________________________________________________________________________
__________________________________________________________________________________
Phone: _____________________________________
Email Address:_______________________________
Airport pickup from Charlottesville? ☐ Want carpooling information? ☐
Enclosed is: The deposit only of $50 (balance due by June 1st) ☐
Tuition only of $350 ☐ Room/Board $485 (includes tax) ☐
Room/Board and Tuition of $835 ☐
Commuters: $72/day includes the facility day rate, lunch and dinner
For more detailed information regarding the cost for children and how to lower the room and
board cost, please visit the Course Details section on our Workshop page.
For those who don’t eat chicken, fish, wheat and dairy, alternatives can be provided.
Please list dietary needs ____________________________________________________________
_________________________________________________________________________________
Roommate request_________________________________________________________________
For questions concerning the workshop or registration, please contact:
janbaty7@gmail.com (302) 368-5141
Print form and mail check payable to:
Jan Baty
807 Kenyon Lane
Newark, Delaware 19711
