one sixty glass glassblowing class registration

Date

 

Name

 

Address

 

City

 

State, Zip Code

Telephone Number home
  work
  mobile

Class that you are interested in:

 

Your glass experience:

 

I would like to be on the waiting list if the class is full

Yes No please choose one

 

Required materials eye protection (glasses, sunglasses, etc.)
  no open-toed shoes
  100% cotton clothes
  a sock (optional)

Payment Options (circle one)

Credit Card Check/Money Order Cash

 

Credit card payment option:

Carholder's Name

 

Billing Address

 

Card Type (circle one)

Visa Master Card American Express

 

Card Number

 

Expiration Date

 

Verification code

 

Please print this form, fill out completely and fax to 718 486 9615 or mail/deliver to:

one sixty glass
160 berry street
brooklyn, ny 11211