Tunisian Workshop Registration Form

Name:_______________________________________________________

Address:_____________________________________________________

Telephone: (work)______________________________
(home)______________________________

Email:____________________________________________

____Tunisian Workshop @ $40 prepaid by February 12^th

____Tunisian Workshop @ $45 paid after February 12^th

Please note that to receive the reduced rate, your registration must be postmarked by Saturday, February 12^th, 2005.

Checks accepted on or before February 12^th. After February 12^th, cash or money order only.

Please make checks payable to Amara and send to P.O. Box 3975, Gaithersburg, MD 20885.