Registration Form

Songwriting Weekend Registration Form
Name	_____________________________________________________
Address	_____________________________________________________
City	_____________________________________________________
Province/State	_____________________________________________________
Postal/Zip	_____________________________________________________
Phone	_____________________________________________________
E-mail	_____________________________________________________
Payment
Cheque/Money Order	Make cheque or money order payable to Pipe Street Publishing.
Visa/MC #	_____________________________________________________
Expiry Date	__________
Mail registration form and payment to: Pipe Street Publishing Box 714 Guelph, ON Canada N1H 6L3