Registration Form
Please fill out the form carefully for registration. You will be asked for payment. If you would prefer to pay by an alternative method, please contact pam@poemacrafts.co.uk
Student Name
*
First Name
Last Name
Address
*
Number/Street
Town
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
County
Postcode
Age ONLY if under 18yrs
(no age required for adults attending classes.)
Student E-mail
*
Confirmation Email
Phone Number
*
Is there anything your tutor needs to be aware of before you take part in this course? (Medical conditions, allergies, mobility concerns etc)
Select your choice of course date:
*
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Saturday 10th August
£
65.00
9am - 1pm
Total
£
0.00
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