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.:
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