Workshop Registration Form

Oxton House Publishers, LLC

P. O. Box 209, Farmington, ME 04938

1-800-539-READ Fax: 207-779-0623

www.oxtonhouse.com info@oxtonhouse.com

for Purchase Orders or check payments by mail
(Register and pay online with MasterCard, VISA, or Discover.)

Workshop: “Make Decoding Automatic!” by Dr. Phyllis E. Fischer
Location (city): _________________________ Date: ______________

Fee: _________, including continental breakfast and lunch. See website for details.
($25 early-bird discount if paid or committed with Purchase Order by cutoff date.)

Participant: Name: ________________________________________________

                    Mailing Address: _________________________________________
                                              _________________________________________
                                              _________________________________________
                    Phone: __________________ E-Mail:________________________

(for workshop
information)

___ Check enclosed

___ Purchase Order, as follows:

School or Organization:_____________________________________________

              Billing Address: _____________________________________________
                                      _____________________________________________
                                      _____________________________________________
              Contact Name & Phone: ______________________________________
              Purchase Order Number: __________________________

(Please FAX or mail P.O. with this registration form.)

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