Debater's Toolbox
June 18 & 19, 2005
at the Center for Inquiry-West

Registration and Payment Form

General Admission: $49
Friends of the Center: $44
Students: $25
 

            Name: ______________________________________________________

            Address: ____________________________________________________

            City: _________________________________________________

            State: ______________    ZIP: ____________________________

            Daytime phone number: __________________________________

Method of Payment:

           _____ Visa                    _____ American Express

           _____ MasterCard        _____ Personal check or money order

Credit Card Number:________________________________________    Expires:  _____ / _____

 ____  General Admission: $49        _____  Friends of the Center: $44         _____  Students: $25

 
Total:  $____________

Signature:  ____________________________________________  Date: ____________________


Please make checks payable to:    Center for Inquiry-West
Mail or fax to:                               4773 Hollywood Blvd.
                                                    Hollywood, CA  90027
                                                    fax (323) 666-4271