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Name:_______________________________________________________________________________

Address:______________________________________________________________________________

Phone: Home:_____________________  Work: _____________________   Cell: ____________________

Enclosed is my fee for the selected class time: CIRCLE ONE
PLEASE MAKE CHECKS PAYABLE TO HILLARY BLACKTON
Tuesday 10:00 a.m. / Wednesday 10:00 a.m. / Wednesday 5:30 p.m. /
Thursday 10:00 a.m. / Thursday 7:00 p.m. / Saturday 10:00 a.m.

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Print this page and return the form with your check made out to HILLARY BLACKTON to:
Hillary Blackton
Divine Life Yoga
19008 High Point Drive
Gaithersburg, MD 20879-3402

Call Hillary Blackton at 301-924-5164 or email hillary@divinelifeyoga.com if you have any questions.

Return to the Divine Life Yoga Web Site