Name________________________________________
Address______________________________________
City_________________________________________
State __________________         Zip code__________
E-mail: ______________________________________
Home Phone___________________________________
Cell Phone ____________________________________

Pre Registration fee: $160                          _________
(Refundable up to one week prior to workshop)

Do you want the DVD and hoop before the workshop.   
If so, include $ 10 for shipping                   _________

Would you like a Hooked on Hooping t-shirt (additional cost $15)    _________
Please circle which size you would like:
Adult  SMALL  MEDIUM       LARGE     X-LARGE

TOTAL AMOUNT ENCLOSED                 _________

If you already have the Hooked on Hooping DVD, you can replace it with a t-shirt. Please indicate that, and your size on this form.
_____________________________________________

Do you need assistance with hotel accommodations or shuttle service to and from the airport, please indicate here:
_____________________________________________