Name:

Street Address:

City:   State:   Zip: 

Phone:   Alternate Phone:

e-mail address:

Are you a:

Full-time lake resident

Part-time lake resident

Visiting friends

Vacationer

Have you worked with glass before?   Yes  No

Do you have your own glass tools?      Yes  No

Do you hate/faint at the site of blood?  Yes  No (if yes, you may want to reconsider working with glass!)

YES - I need to rent tools for my session 

I want to pre-register for:

Do you have special needs the teacher needs to be aware of?  
If so, please explain below (will be kept confidential)

Comments & other class suggestions:

We will will call or e-mail you to confirm your pre-registration.  To avoid being charged for the class, please cancel two days before class, to allow time for another student to take your place.   

Note: Eye protection is required during class...please bring them when you come.  We will also have some available for you to purchase.