PROGRAM REGISTRATION

Name of Program/Class_________________________________________________________

Day and Date of Program/Class ______________________________ (ex. Thursday, Jan. 19)

Parent’s Name _____________________________________

Participant/Child’s Name ________________________ Age/D.O.B. ____________________

Mailing Address ____________________________________

City/State/Zip _____________________________________

Home Telephone __________________________ Cell/Work Telephone _________________

Registration Fee Due ______________________

Registration Fees should be mailed along with a copy of the registration form. Make checks payable to Woman’s Foundation. Confirmation will be mailed upon receipt of fees and registration form.

Mail registration and fees to:

Woman’s Foundation, Inc.

4630 Ambassador Caffery Parkway, Suite 100

Lafayette, LA 70508

For more information call: Lisa LeBlanc, Community Program Coordinator

(337) 988-1816 - Email - wficpro@bellsouth.net