Midwest School of Herbal Studies

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Message BoardHerbal Clinic

 

Students, Please Join Us for Our Third Summer Wild-Plant Walk....

Date & Time to Be Announced Shortly....

 

REGISTRATION FORM

Student Name:...........................................................  Student I.D. #..............................

Email Address ...................................................................................................................

Phone Number .................................................................................................................

Day & Hours: 

Total Cost:     Payment Enclosed:  (Check)......(M.O.) .....(C.C) .....

If paying by Credit Card, you must supply all of the following information in order for us to process.  Note: Will clear as “Midwest Herbs & Healing.”

Credit Card Number.......................................................................................................................Expir. Date.............

CDC Code (last group of 3- or 4 digits in series of numbers on reverse of card near signature strip) ........................................

Digits of Mailing Address to which Credit Card Bill goes to:.................................................................................

Zip Code of same address...........................  Telephone Number   (          )..............................................................

Fax this form to the School at 651-484-0426 or snail-mail it to us at P O Box 120096, New Brighton MN 55112