Printable Top Floor Learning Course Registration Form
Print this form and mail, fax, or bring it in personally to:
Top Floor Learning, 1455 North Main Street, Palmer, MA 01069. FAX: (413) 283-9970 Phone: (413) 283-2329
Registrant Information
Name: __________________________________
Address: ______________________________
City: ___________ State: ____ Zip: _____
Day phone: ___________________ Evening Phone: ___________________
Email: ________________________________
Course Information
Course Name 1: ___________________ Start Date: ___________ Cost: ___________
Course Name 2: ___________________ Start Date: ___________ Cost: ___________
Course Name 3: ___________________ Start Date: ___________ Cost: ___________
Subtotal: ___________
Payment Information
Payment by: _____ Check _____ Money Order _____ Cash in person
Please do NOT send cash through the mail. TFL is not responsible for lost payments.
Miscellaneous Information
How did you hear of TFL? ________________________________________________
Additional comments, questions or pertinent information, Special needs, etc.:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
|
|