Company:         

                                                       Address 1:        

                                                      Address 2:         

                                                                 City:              State:        Zip:

                                                      Telephone:               Fax:  

                                             Attendee Name:         

                                                    Class Name:       

                                                    Class Date:          month July August September October November December

                                                E-mail Address:          Tuition: $ 

                                                                                        Method of Payment

                                      I will mail a check (When payment is received, you will receive confirmation)

                                               Please charge my credit card (Call to arrange credit card payment)

                                                        Visa, Mastercard and Discover accepted