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Name: Address: Phone: Email: Which class(es) are you signing up for? (Please list title and date.) ________________________________________________________________ Cost: ________ ________________________________________________________________ Cost: ________ ________________________________________________________________ Cost: ________ ________________________________________________________________ Cost: ________ ________________________________________________________________ Cost: ________ Total payment: $ _______ Send check made payable to Sharon A. Kane, 18 Cedar Hill Road, Ashland MA, 01721 Briefly describe your current diet and health situation: |