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China Mending and Restoration |
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Please print and complete this form, mailing it, along with your check, |
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| to the address at the foot of the page. | ||||||
| Name: ___________________________________________________ | ||||||
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Last (please print), |
First | |||||
| Street Address: _________________________ | Apt:__________ | |||||
| City: ______________ | State: _______ | Zip: __________ | ||||
| Tel: ______________ | E-mail:________________________ | |||||
| Where did you hear about this course? __________________________________________________ | ||||||
| Special Interests (ceramics): __________________________________________________ | ||||||
| I would like to attend: | ||||||
|
O |
July 11 - July 18, 2010 | |||||
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O |
July 18 - July 25, 2010 | |||||
| If your chosen class is filled, which of the others could you attend? __________________________________________________ | ||||||
| Course Fee: | $1800.00 | |||||
| Registration Deposit: | $ 500.00 | (Balance of $1300.00 due by June 1 2010) | ||||
| Please mail check with this form, for at least the value of the deposit. | ||||||
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Mail to: |
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Gerlinde Kornmesser, 1705 Glenview Rd. • Glenview, IL 60714 |
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Tel: 847-724-3059 |
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