(Please Print or Type)
Name: __________________________________________

Address: ________________________________________

City: ___________________________________________

State: ___________________________ Zip: ___________

Telephone: (day) __________________________________

Telephone: (evening) ______________________________

Fax: ___________________________________________

E-mail: _________________________________________

AAEA Associates and Full Members receive a 20% discount off tuition.
Donors, Corporate and Life Members receive a 10% discount off tuition.
Early enrollment: 10% discount off tuition for any student enrolled 90
days prior to start of workshop. (Only one discount may be used per workshop.
Discounts may not be combined.)

Please indicate discount if applicable:

____ Associate and Full Member, 20% discount = $360 per workshop (unless stated otherwise)

____ Donors, Corporate and Life Members, 10% discount = $405 per
workshop (unless stated otherwise)

____ Early enrollment, 10% discount = $405 per workshop (unless stated otherwise)

Payment enclosed in the amount of $ ________

Form of Payment: check VISA M/C

Card #___________________________________________

Exp. Date:_____________________ Numbers on back of Card:_______________

Name as it appears on card:___________________________________________

Where did you hear about the AAEA workshops?

______________________________________________

Have you previously attended an AAEA workshop? ________

If yes, please list which ones:

_________________________________________________

LIST NAME OF INSTRUCTOR AND WORKSHOP DATES
YOU WISH TO ENROLL IN

1) ________________________________________________

2) ________________________________________________

3) ________________________________________________

4) ________________________________________________