AGD New England Master Track Program

New Member Registration

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New England Masters Study Club

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New Member Registration Form:
New England Master Track XI
Name: _______________________________________
Address: _____________________________________
City: ________________________________________
State: __________________ Zip: __________________
Contact Numbers (please note your preferred method):
Home: _______________________  Office: _______________________
Cell: ________________________  Fax:  __________________________
Email: _______________________
AGD#: ______________________________________
Year of Fellowship (if you have it)  ____________________________
___________________________________________________________________

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Please note, this registration is for Track 12, beginning  September 2018.
To reserve your spot,  print this page and send the completed form with a check for $795.00 to:

Dr. Hsung Lin
Treasurer, Master Track X
52 Barstow Ln.
Tolland, CT 06084

(c) 804-304-8016
(o) 860-276-9565
(e) hsung13@gmail.com

*All checks should be payable to: New England Master Track Program. Please note: the total tuition is subject to change by vote of the current membership in order to meet the financial obligations of the organization. Our goal is to keep tuition at a minimum yet still attract speakers of the highest caliber in their respective fields. All reserved members of future tracks will be notified of any tuition changes well in advance of the start of the next track.