PRE-REGISTRATION FORM
Until we open on September 1st, we ask that you print and mail this form to us You may pay with a check or if you have been a previous Elements student, email the class and contact info to us. This is a printabe form. Do not send cash through the mail. Our fax is not set up yet.
Zen And Now Clay Studio
2534-D Royal Place
Tucker, GA 30084
678-534-5436
info@ZenAndNowClayStudio.com
Student Name: ____________________________________________________________________________________
Street Address: ____________________________________________________________________________________
City: _______________________________________________ State: _____________________ Zip: ________________
Daytime Phone: ____________________________________ Evening Phone: ___________________________________
E-Mail: ___________________________________________________________________________________________
Course Number: _____________________________
Instructor: __________________________________ Day/Time:_________________________
_________________________________________________________________________________________________
Method of Payment: ____ Check enclosed ____Credit Card (Do not mail cash)
Amount _________________________
Credit card number __________________________________________________________________________________
Card Type _________________________ Expiration Date: ___________________________
Name on charge card ________________________________________________________________________________
Billing Address, if different from above: ___________________________________________________________________
