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A  P  P  L  I  C  A  T  I O  N

Rehearsals for Growth
Certificate Program

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 prefer the Leverett, MA location

___ I prefer the Greater Hartford, CT location

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

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

___ I wish to attend the RfG Conference (November 11-13, 2011) and
meet the Beginning Level Training Requirements (tuition savings of $185)

Please enclose your $250.00 deposit
Send checks made payable to: "Rehearsals for Growth" to:

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

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