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(Please Print)
Name: ____________________________________________________
Address: ____________________________________________________________
City: ________________________________ State: _____ ZIP: ________________
E-mail address: _______________________________________________________
Phone (day): __________________________ (evening): _______________________
Cell (optional): _________________________
Eight Week Class & Starting Date Tuition: $480 plus materials
Please check one. Day Classes______ or Evening Classes______
Starting Date:____________ Jewelry Fabrication:____ Wax Carving & Casting: ____ Lapidary: ____
Two Day Weekend Workshop-Tuition: $240 plus materials Date:____________Title:______________________________________________________
Three Day Weekend Workshop -Tuition: $360 plus materials
Date:_____________ Title:________________________________________________
Expanded 5 Day Workshop -Tuition: $ 600 plus materials
Date:
_____________ Title:________________________________________________________
One-on-one Appointment-Tuition: $40 per hour plus materials
Date:____________Topic:________________________________________________ Minimum $40 deposit for the first hour.
If paying by check, make payable to: Ruthie Cohen / MMSJL
Pay by Check: ____ Check # __________
Pay by Charge: __ MasterCard __ VISA __ Discover __ American Express Card #: _______________________________________ Exp. Date: __________
Name on Card ___________________________________V-Code on back: _____ All class or workshop reservations require a $25 deposit with this registration form if not paid in full.
Upon receipt of this form via mail or fax, we will confirm your reservation. Due to limited class sizes, we will not deposit your check or charge your credit or debit card if we cannot fill your class request.
CANCELLATION POLICY: Students who cancel last minute after being accepted will be charged a $25 administrative fee.
No refunds will be made after the starting date of a class. Classes without a minimum number of registrations may be cancelled and a full refund will be due to students.
You may MAIL this form back to: MMSJ&L, 197 Locust Ct, Arden, NC 28704 or FAX this form back to: (360)684-7830
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