REGISTRATION FORM

Print this form.
	Type or write clearly.
			Fax a copy to HSLC:(215) 222-0416

CLASS YOU ARE REGISTERING FOR: 
			_________________________________________________________

            DATE OF THE CLASS: 
			________________________________________________________

Are you:   ___ a member of HSLC  
	   ___ HSLC Colleague* 	(payment by credit card only) 
	   ___ Non-member*      (payment by credit card only) 
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Name:
____________________________________________________________________________________________________

Institution:
________________________________________________________________________________________________

Address:
__________________________________________________________________________________________________

City: __________________________________ State: _______________

Zip: _____________________

Phone _________________________   

Your HSLC Username or Internet address  ____________________________

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
PLEASE CHECK:

Method of Payment: ___  Send Invoice  ____VISA  ___MasterCard  ___AmEx

If paying by credit card:
			Card number:____________________________________
                        
			 Exp. Date: ____________________

Card holder's signature:
			__________________________________________

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

IF YOU MUST CANCEL A REGISTRATION:  Please notify HSLC 24 hours before the
class is scheduled. 

HSLC will bill the registrant $25 for failure to attend a registered session.
   A 24-hour cancellation notice is required to waive this fee.

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	HSLC is located at 3600 Market St., Suite 550, Philadelphia, PA, 19104
		near Drexel University. Convenient parking just across Market St.
			Phone (215) 222-1532
________________________________________________________________________________

	* Non-members and Colleagues do not receive the discounted Member rate. 

2/29/00