Information on this form is for my use only. It helps me to get to know you and
your needs. Please consider anything you enter here to be between you and me.
It will not be shared without your permission.
First name
Last name
Middle initial
Work Phone
Home Phone
FAX
E-mail
URL
Best Time to contact you
How would you rate your painting experience level? (1 = beginner, 5 = very experienced)
1 2 3 4 5
What classes would you be interested in?
Weekday
Evening
Weekend
Any
Private
Are you interested in Floral Classes?
Yes No
Are there other locations that would be more convenient for you to attend?