Registration Form

Registration Form - Fall/Holiday 2011 Classes
Please copy a form for each person registering - Please fill form out completely

Name:

_____________________________________________________________________

Street:

__________________________

City:

__________________________________

State:

__________________________

Zip:

___________

Phone:

_____________

Email:_____________________________________________________________________________

Parent/Guardian Name (for children under 16): ____________________________________________

How would you like to receive your confirmation [ ] via email [ ] via regular mail

Class Name/ Session, Date or Time (if choice)	Amount Due







[ ] Yes, I would like to reserve a sewing machine for a Quilting Class




Total Due

[ ] Check (Payable to Sauder Village) [ ] MasterCard [ ] Visa [ ] Discover [ ] Am Express

Card #:

______________________________

Expiration Date:

________________

V-code #

____________________________ (last 3 digits on signature line on back of card)

Signature:

___________________________________________________________________

Mail with payment to: Classes, Sauder Village, PO Box 235, Archbold, Ohio 43502
If paying by credit card, registration can be FAXED to 419.445.5251