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REGISTRATION

This independent study class may be used by any person or program for free. I would appreciate an email to let me know you have chosen to use some or all of its pages.

If you would like me to provide the online instruction and feedback, the cost is $300.00 per student or by hourly contract with a school.

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Date:

Student Information	School Information
Name	Name
Address:	Address
Town	Town
State	State
Zip	Zip
Phone	Phone
email	Fax
SS #(optional)	email
	Contact Person

COURSE INFORMATION

COURSE NAME	COST
___________________________________	___________
___________________________________	____________
___________________________________	____________
	TOTAL COST____________

Please send with check, money order, purchase order to:

Beverly Stone

Creative Solutions

84 Payson Road

Brooks, ME 04921

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