EmailMe Form - Gift certificat registration form

From

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

Phone

### - ### - ####

Recipient information

First Last

The recipient is:

A child

An adult

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

Phone

### - ### - ####

Please select your package

12 hours

15 hours

30 hours

others

Please select your gift program.

Individual classes

Group classes

Children group classes

Wednesday classes

Saturday morning classes

Saturday afternoon classes

Adult group classes

Evening classes 6 to 8 pm

Saturday classes (1 to 3pm or 3 to 5pm)

Payment
All teaching material for adult classes are not included in these fees and have to be paid separately.

Method of payment
Payments can be made by cash or cheque payable to École Napoléon. *

I agree

Signature Initial

Date Time

MM / DD / YYYY