Loving and Caring - My Baby and Me Training Registration

Register for the My Baby and Me Training using the form below. You may submit your payment for lunch ($10 per per person) using your credit card information on this form or you may send a check. (Checks may be sent payable to Loving and Caring at: 219A Witmer Road, Lancaster, PA 17602). Space for the training is limited to 50 people.

Please do not hit "Enter" on your keyboard before you complete the form - it will send your incomplete information. Use the "Tab" key to advance through the form.

If you have any questions, please call us at 717-293-3230.

This is a secure area

Contact Person:

Organization:

Address:

City:

State:

Zip Code:

Daytime Phone Number:

Evening Phone Number:

Email Address:

Please list the names of everyone you are registering (including contact person):

Fees:

Registration is free. The only charge is the $10.00 per person lunch charge.

Total number of people needing lunch:

Total for lunch ($10.00 per person):

Method of Payment:

Please make checks payable to Loving & Caring

Credit Card Number:

Expiration Date:

Security Code:
(usually a 3 or 4 digit number on the signature strip)

Please tell us how you heard about this event:

Any additional comments?