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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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