EmailMe Form - Master Class - Gorodetskaya Rospis

STUDENT 1 INFORMATION

Student's Full Name (First and Last) *

Age *

Birthday *

MM / DD / YYYY

Grade in 2016-2017

MASTER CLASS SELECTION

Please selected classes for this child only, price includes all materials

Child 1 class selection

Gorodetskaya - ages 6+, February 3, 4:30-6:00

STUDENT 2 INFORMATION

Student's Full Name (First and Last)

Age

Birthday

MM / DD / YYYY

Grade in 2016-2017

MASTER CLASS SELECTION

Please selected classes for this child only, price includes all materials

Child 2 class selection

Gzhel - ages 6+, January 21, 1:30-3:00 - $40

STUDENT 3 INFORMATION

Student's Full Name (First and Last)

Age

Birthday

MM / DD / YYYY

Grade in 2016-2017

MASTER CLASS SELECTION

Please selected classes for this child only, price includes all materials

Child 3 class selection

Gzhel - ages 6+, January 21, 1:30-3:00 - $40

PARENT INFORMATION

Full Name (first parent or legal guardian) *

Full Name (second parent or legal guardian)

Address *

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

Home Phone *

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

Work Phone

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

Cell Phone 1 *

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

Cell Phone 2

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

Email 1 *

Email 2

Additional contact information in case of emergency (phone #, name, relation)

Whom can we thank for recommending us?

PAYMENT IS NOT REFUNDABLE UNLESS THE CLASS IS CANCELLED BY EVRIKA FOR ANY REASON. TO COMPLETE YOUR REGISTRATION AND RESERVE THE SPACE, PLEASE CLICK ON "SUBMIT" AND THEN PROCESS THE PAYMENT.

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