Class/Workshop Registration Form * = Required information
First Name:*	Last Name:*
Address line 1:*
Address line 2:
City:*	State:*	Zip:*
Day Phone:*	Eve Phone:*	E-mail:*

Have you taken classes before? No Yes If so, with whom?
How long have you been doing stained glass? First Timer 1-3 Months 3-6 Months 6-12 Months 1-2 Years 3-5 Years 5+ Years
Rate your level of experience: Beginner Intermediate Advanced
Why are you interested in learning to do stained glass?	Which night would you prefer? * Please select a 1st and 2nd choice
	Monday	Beginner Staid Glass Please select
	Tuesday	Please Select 1st choice 2nd choice Unavailable Beadmaking
	Wednesday	Please Select 1st choice 2nd choice Unavailable
	Thursday	Please select Fusing
Any additional comments or questions?	Saturday	None Available
	How did you hear about us? Please let us know Magazine Newspaper Internet Word of Mouth Radio Yellow Pages Other
	Please specify: