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REGISTRATION FOR THE LA JOLLA BRANCH
(use for Sunday Workshops only)
PLEASE COMPLETE ALL FIELDS
Program(s)
Name
Address
City/State/Zip
Phone
Email Address
Total enclosed
at $15.00 per workshop
Make check or money order payable to ITIP-ACIM (US funds only)

Please note that registrations for the Sunday workshops should be sent to the address below, rather than to the Temecula office. In addition, FACIM-La Jolla is unable to accept credit card payment.

PLEASE PRINT OUT THIS SCREEN, AND MAIL TO:

FACIM-LA JOLLA
7843 Girard Avenue, Suite E
La Jolla, CA 92037

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