AFO REGISTER

Please select your Course location
	Richmond, VA - October 8-9, 2008
	McGaheysville, VA - November 11-12, 2008
	Roanoke, VA - March 4-5, 2009
	Virginia Beach, VA - March 11-12, 2009
	Fairfax, VA - April 1-2, 2009


Number of Attendees for the complete course
Number of Attendees for last day recertification
2-Day Recertification	Qty.
Number of Retests	Qty.
Extra AFO Manual	Qty.
Full Name(s)
Address or PO Box

City
State/Province
ZIP or Postal Code
Telephone
Fax
E-mail address

Shipping Address (if different from above):
Full Name
Address

City
State/Province
ZIP or Postal Code

I will make the check payable and mail it to Harper and Company*.
Please call me back for the credit card information**.