classenrollment

CLASS
ENROLLMENT

Your Name: _________________________________________________________________________________

Address: _____________________________________ City, State,Zip: _____________________

Phone: _______________________________________ Second Phone: ____________________

Class Name:___________________________________ Class Date: __________ Fee: ________

Class Name: ___________________________________ Class Date: __________ Fee: ________

Class Name:___________________________________ Class Date: __________ Fee:_________

Class Name: ___________________________________ Class Date: _________ Fee:_________

Credit Card Number: ______________________________________

Expiration Date: __________________________________________

Print this page, fill out in pen, and mail to:
Prairie Quilt, 101 S. Main St., Hennessey, OK 73742
[keeping copy for yourself]

-OR-

Copy text into body of an email, fill in the blanks,
and send email to Randa@PrairieQuilt.com