The EduCulture Project at

FARM HANDS REGISTRATION FORM

Please PRINT, complete, and return this form with check or payment information to:
Global Source Education, PO Box 11316, Bainbridge Island, WA 98110

You can register by phone during office hours at 206-780-5797

Return to Farm Hands

Monthly Program- 1 session left! $65	Nov. 3, 11:30-5:00pm
10% Discount $_______ 10% Discount $_______	Sibling Returning Families (Please contact us for information about reduced tuition for financial need.)
$35 $_______	Global Source Membership/Contribution Other Tax Deductible Contribution to support Farm Hands and the EduCulture Project.
$_______	Total Amount Due
Name of Child Parent/Guardian
Mailing Address
Day Phone

E-Mail
School & Grade Level
Notes

Please make checks payable to: Global Source Education
Credit Cards (Visa or MasterCard) accepted
Credit Card Information    MasterCard     Visa    Exp Date ____/____
Credit Card Number    __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Parent/Guardian Signature  (required) ____________________________________
Date ________________