Mail-in Registration form

Using Genline workshop
Carl Sandburg College
Galesburg, Illinois

28-29 August 2009
8:30 until 3:00 each day

Name:______________________________________________

Address: ____________________________________________

City/State/Zip: ________________________________________

Date of birth (for registration purposes): ____________________

Phone: _________________________________________

Email address: _________________________________________

If registering by mail, make check for $80 payable to Carl Sandburg College.
Mail to:

Michael John Neill
Genline Workshop
Carl Sandburg College
2400 Tom L. Wilson Blvd.
Galesburg, IL 71401

Thanks!