China Mending and Restoration

Please print and complete this form, mailing it, along with your check, 

to the address at the foot of the page.
Name:  ___________________________________________________

Last (please print),

First
Street Address:  _________________________ Apt:__________
City:  ______________ State:  _______ Zip: __________
Tel:   ______________ E-mail:________________________
Where did you hear about this course?  __________________________________________________
Special Interests (ceramics):  __________________________________________________
I would like to attend:

O   

July 11 - July 18, 2010

O   

July 18 - July 25, 2010
If your chosen class is filled, which of the others could you attend?  __________________________________________________
Course Fee: $1800.00
Registration Deposit: $  500.00 (Balance of $1300.00 due by June 1 2010)
Please mail check with this form, for at least the value of the deposit.

Mail to:

Gerlinde Kornmesser, 1705 Glenview Rd. Glenview, IL 60714

Tel: 847-724-3059

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