LOCATION:  St. Mark’s Lutheran Church, 2300 Washington, Evansville 47714

This hands-on keyboard adventure is open to the first 20 applicants.

REGISTRATION FEE:  $10.00 which includes all materials plus lunch.
REGISTRATION DEADLINE:  Friday, February 19, 2007.
QUESTIONS?  Please contact Helen S. Reed, 812-476-0673, hsr@evansville.net.
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YES, sign me up for PEDALS, PIPES, AND PIZZA , FEBRUARY 19, 2007!

Please complete this form and mail it by February 16, 2007 to:
Helen S. Reed, Education Convener, 1435 Brookside Dr., Evansville IN 47714
(You may copy this page and paste into your word processor for printing.)

Please enclose a check or money order for $10, payable to Evansville Chapter A.G.O.

Name:  _______________________________________________________________________

Address:  _____________________________________________________________________

City:   __________________________  State/Zip:  ________________Phone:  ______________

Date of Birth: _______________  School:  _____________________________  Grade:  ______

I have taken piano lessons for ___________ years.

I have special dietary requirements: ________________________________________________

This student (if under age 18) participates in PEDALS, PIPES, AND PIZZA with my permission.

Signature of Parent or Guardian:___________________________________________________