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Aqua Vita Farms Two Day Aquaponic Training Course May 31st June 1st, 201 !

egistration Form
In order to guarantee your reservation please fill out all sections below and mail to: Mark E. Doherty, 1 ! "arts "ill #er. $hitesboro %&, 1'(!). *lease include a check or money order for the full sum, made payable to Mark E. Doherty or indicate payment via *ay*al. *lease note the cut off date for the discount rate is +pril ' th, no registrations will be accepted after May )'rd. If registering multiple participants please use separate forms, however, one check, money order or *ay*al invoice may be used for payment.
%ame ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

+ddress,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

#elephone -,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,


"ow would you like reservation confirmation:

*hone . Email

Method of *ayment:

/heck . Money 0rder . *ay*al

#12hirt 2i3e:

2 . M . 4g . 5lg . )5lg

2ignature,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 6&our signature indicates that you are registering for a two day non1refundable a7uaponic training course administered by Mark E. Doherty and +7ua 8ita 9arms /onsulting, 44/: