Please print out this form, fill it out completely and mail it with your check or money order for $25.00 members or $40.00 Non Members to:

APPGA

C/O Madeline Marino/seminar registration

P.O. Box 5733

Scottsdale, Arizona  85261

October three breed Seminar

First Name:________________    Last Name:_________________

Address:__________________________________________________

Business Telephone Number:___________________________

Home Telephone Number:______________________________

Cell Phone Number:____________________________________

Business Name:___________________________________________

Are you an A.P.P.G.A. Member ?   Yes      NO

Are you interested in becoming a member of the A.P.P.G.A.?    Yes       No

Comments:_________________________________________________

_____________________________________________________________

______________________________________________________________

**REMEMBER TO INCLUDE YOUR CHECK OR MONEY ORDER**