Dorothy Lesher's Starlight Waltz - Mail-in Registration

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ANG Number:
First Name:	Last Name:
Address:
Apartment Number: (if applicable):
City:
State (or Province):
Zip (or Postal) Code:	Country:
Home Phone:	Work Phone:
e-Mail Address:
_________ Instruction Booklet and Kit Payment Amount: U.S. Members ______ Class fees, course booklet, complete kit, and postage: $175.50 Canadian Members ______ Class fees, course booklet, complete kit, and postage: $193.00 International Members ______ Class fees, course booklet, complete kit, and postage: $211.00
Payment Method: _______ Check (enclosed with this form) _______ Charge my credit card MasterCard or Visa (circle one) Number: ________________________________________ Expiration Date: __________________________________ Signature:_______________________________________

To register, your membership must be current with ANG's national membership office. Check the mailing label of your most recent issue of Needle Pointers for your membership number and the expiration date. Your payment must accompany this form.

Payment may be made by check or by Visa or MasterCard. Please make checks out to ANG; please write your ANG membership number on your check.

All payments are final.

Mail the completed registration form and your payment to:

ANG CyberWorkshop
2424 American Lane
Madison, WI 53704-3102
Fax: 608-443-2474

Your completed registration form and payment must be postmarked or faxed by March 31, 2012.

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