Registration form for classes at Institute of Mosaic Art

Please fill out this form and include it with your registration check.
If you can not download or print this please include this info on your own paper. 


Name:______________________________________________________

Address: _________________________________________________

___________________________________________________________

____________________________________________________________

Phone numbers: 
	
Day: __________________ Eve: __________________ Cell: _________________

Email address: ___________________________________________

Name, date, and fee of course(s) you are registering for:

Name                                               Date        Fee

____________________________________________     ___________   _____________

____________________________________________     ___________   _____________

____________________________________________     ___________   _____________

                                                 Total fees:   _____________

Are you a new or returning student? _____________________	

Other courses taken at True Mosaics or Institute Of Mosaic Art : __________________

______________________________________________________________________________________

How did you hear about Institute Of Mosaic Art? ____________________________________
			
Send to:
Institute of Mosaic Art
3001 Chapman St.
Oakland, Ca 94601

Please Make Checks Payable To:  "Institute of Mosaic Art".
Separate materials fees payable to instructor on the first day of class.