Berks Bead Bazaar

2004 Class Registration Please print and mail to The Glass Place, 1426 Delaware Ave, Wyomissing PA 19610.
You will receive confirmation by email or mail.

Name_____________________________________________

Street Address_______________________________________

City__________________________State_______Zip________

Phone____________________Email______________________

Class Selection:

1. Title________________________________

Day/hours__________________

Class fee $_______+ Kit fee $_______= Total fee $_______

2. Title________________________________

Day/hours__________________

Class fee $_______+ Kit fee $_______= Total fee $_______

3. Title________________________________

Day/hours__________________

Class fee $_______+ Kit fee $_______=Total fee $_______ TOTAL FEES $___________

Enclose check (made out to the Glass Place) or bill my VISA or MC

Account #___________________________Ex date_______

Signature____________________________________

For more information, email Joan at [email protected] or Marti at [email protected]

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