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A  P  P  L  I  C  A  T  I O  N

Rehearsals for Growth
Certificate Program, 2009-10

NAME___________________________________________

ADDRESS________________________________________

CITY______________  STATE_____  ZIP______________

PHONES      W:       (           )_________________________

                      H:        (           )_________________________ 

                      C:        (           )_________________________ 

EMAIL__________________________________________

Graduate Degree in ______________________________ OR
Graduate Program Currently enrolled in:

________________________________________________
                                   
If you have taken previous RfG workshops/Courses indicate where and when:

___________________________________________________________

___________________________________________________________

___ I wish to apply for the 3- intensive weekends' training

___ I wish to apply for the 7- all-day Fridays' training

Please enclose your payment for $250.00 (applicable to tuition;
refunded if you are not accepted into the program).

Send Application page copy, along with checks made payable to:
"Rehearsals for Growth," to:

Rehearsals for Growth, LLC
81 Long Plain Rd.
Leverett, MA  01054

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