Register for the Clarkesville Seminar
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Use this form to register for the Clarkesville Seminar on 9/18/12
 

 
Name:   License No. or SSN:
Address:   Phone No.
City:   Fax No.
State:   E-mail Address:
Zip Code:   Company Name:
 

For those holding a North Carolina License

  
If you need credit for your NC license enter the last four of SSN:
 

Pay at Door

  

 Mail Check

  

Invoice

  

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J & W Educational Services
1340 Hickory Hill Dr.
Watkinsville, Ga 30677
(706) 769-7112		 5032 Northshore Court
Conyers, Ga 30094
(770) 922-7086
E-Mail JandW@uga.edu
Sponsored by UGA