Name ____________________________________

Address __________________________________

             __________________________________

City  ____________________________________

State ________    Zip ______________________

Phone ___________________________________

e-mail ___________________________________

Class Date ________________________________

Amount Due _______________________________

Credit Card No. _____________________________

Expiration Date ____________________________

Signature _________________________________

Important! Deposit and Cancellation Policy

Return this form and 50% deposit to reserve a place in my class. Your balance is due 10 days prior to the first day of class. A refund of the deposit will be given if I am notified no later than 14 days prior to class.

For more information, contact me.