Registration Form

Name: _____________________________________________________ BPR# ___________________________

Address: ____________________________________________________ Phone:___________________________

How did you find out about this program? ______________________________________________________________

Payment type (circle one): Check Credit Card

Please make checks payable to Dodson, Parker, Behm & Capparella, PC and enclose with registration form.

If paying by Credit Card:

Card Type (circle one): Visa MC Amex Discover

Name on card: _____________________________________________

Billing address: ____________________________________________

Card Number: _____________________________________________

Security Code (back of card): _______ Expiration: ___________________

Please charge the $199 registration fee to my credit card

x_________________________________________________________
(signature)

Mail form and payment to:

Donald Capparella
Attn: Who Wrote Shakespeare?
1310 Sixth Ave. North
Nashville, TN 37208
Questions? Call Donald Capparella at 615.254.2291