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The Southern Flames present Julie Ferguson
Reactive Glass
Registration
Form
Thurs & Fri April 23-24 2009
Sat& Sun April 25-26-2009 Wait List Only for Sat/Sun
Name:
Address:
Telephone:
Alternate
Telephone (mobile):
Email Address:
Class Preference:
April 23-24, 2009 (Thursday/Friday)
Do you want to be on the wait list for the Thurs/Fri class if filled? Circle One Yes No
Waitlist for April 25-26, 2009 (Saturday/Sunday).
Please print out, complete, then mail the completed form and your check in the amount of $220.00 (Members) or $245.00 ( Non Members) made payable to “Southern Flames” to:
Southern Flames
c/o Martha Fuerst
2679 Mercedes Drive NE
Atlanta, Georgia 30345-3974
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For Southern Flames Administrative Use Only Please do not fill in below
Received On _________ Check # __________
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