2011 Registration Form
Name: _________________________________
Address:_______________________________
Phone:_________________________________
Cell Phone:_____________________________
Email:__________________________________
Please
Check the class that you would like to register for:
___Beginners Reading Club
___Challenge Reading Club
___Tutoring
Club
There is a $10 registration fee due when you sign up. This fee will be deducted from the total cost of the
class and the balance will be due the first day of class.
Please send registration forms and fees to:
Emily Brown
814
East McNeil
Hoopeston,IL 60942