Class/Workshop Registration Form * = Required information CLASSES ARE $119.00 UNLESS OTHERWISE NOTED. PLEASE BE SURE TO MAIL IN OR STOP BY WITH A $25.00 DEPOSIT TO HOLD YOUR SPOT IN THE CLASS.
First Name:*	Last Name:*
Address line 1:*
Address line 2:
City:*	State:*	Zip:*
Day Phone:*	Eve Phone:*	E-mail:*

Have you taken classes before? No Yes If so, with whom?
How long have you been doing stained glass? First Timer 1-3 Months 3-6 Months 6-12 Months 1-2 Years 3-5 Years 5+ Years
Rate your level of experience: Beginner Intermediate Advanced
Why are you interested in learning to do stained glass?	Which night would you prefer? * Please select a 1st and 2nd choice
	Monday	Evening 6-8:30 Please select
	Wednesday	Please Select Day 10:30-1 Evening 6-8:30
	Friday	Please select Day 10:30-1
Any additional comments or questions?
	How did you hear about us? Please let us know Magazine Newspaper Internet Word of Mouth Radio Yellow Pages Other
	Please specify: