Registration - Conshohocken May 2008

   Name *
Address *
     City * State * Zip *

Phone [Day]:    Phone [Night]:
E-Mail: *

Please check here if you are a first time attendee or if you are updating ANY contact information.
Otherwise, we will not change any of your information in our records.

Level In Irish:

If you recently studied with a teacher, please enter their name here:

Several classrooms are on a hillside. Let us know if you have any special access requirements.

PAYMENT

You can register on the Web and pay by credit/debit card or print out this form and pay by check or money order.

Register on Web with Credit/Debit Card and PayPal

Print Form and Pay by Check:

make your check payable to: Daltaí na Gaeilge and mail it to:

Marcella Reis
209 Wingate Road
Upper Darby, PA 19082

If confirmation of your reservation is required, please enclose a stamped, self-addressed envelope with your Registration Form.

CONSHOHOCKEN REGISTRATION FORM

PAYMENT

Register on Web with Credit/Debit Card and PayPal

Print Form and Pay by Check: