Credit Card Number (if paying by credit card):__________________________
Type of Card: __ Visa __ Mastercard __ Discover
Card Expiration Date: ____________
Classes: Check the box for the section you wish to attend in each time slot.
Beginning Piping___ Intermediate Section I ___ Intermediate Section II ___
Reed Making and Pipe Maintenance ___ Advanced Piping ___
Mick O'Brien Master Class ___
Mighty Session and General Piping Melee ___
Registration Fee - $60.00. Note: For the first time, we are able to offer credit card payments for your registration. Simply fill out the form, with a credit card number (Visa, Master Card or Discover) in the space provided, and paste it into an e-mail. Send the e-mail to firstname.lastname@example.org. If you don't want to e-mail your credit card number, you can fax the form to John at (815) 943-7916. Otherwise, just send a check or money order payable to John Gaffney to:
John W. Gaffney
103 West Sumner Street
Harvard, Illinois 60033
Any questions or concerns, just e-mail John at email@example.com or Bob Kellam at KELLAMR@BCBSIL.COM. Otherwise you can contact John at his office at (815) 943-0900!