Course Registration Form

Let Us Know Who is Coming!
First Name: *
Last Name: *
Phone: *
E-Mail: *

Number of People Attending

Six Wednesday Evenings, Starting January 27th 7:15pm to 8:45pm

Course Cost: $65

Location: Providence Park Campus, Novi Orthopedic Center Building - Conference Room, Main Floor.
26750 Providence Pkwy. Novi, 48374

After you submit this registration form by clicking the "Submit" button below, You will be given the option to make your payment by PayPal or by check.