1. SEND REGISTRATION INFO:
                          : eMail: Copy and paste the form below into an email and send to: web@paintyourgutsout.com             
               OR : Mail to: PO box 5928, Atlanta, GA 31107

2. SEND DEPOSIT:
                          : Send check for the full amount due to PO Box 5928, Atlanta , GA 31107
                   OR : Pay the full amount due via credit card using the link below:

Name:                                                                     Age: 
_________________________________________________________________________

Class Name:                                                            Start Date:
_________________________________________________________________________

Daytime Phone:                                                       Mobile:
_________________________________________________________________________

Email:
_________________________________________________________________________

Address:
_________________________________________________________________________

Any physical, health, or medical problem of which we should be aware:

_________________________________________________________________________

How the deposit will be paid:

_________________________________________________________________________

Comments or questions: