Sign me up! Class title and date you wish to join_______________________

Name _________________address________________________________ 

phone #______________________cell phone #______________________

email address____________________________ 

Check enclosed amount___________ payable to Susan Ticken  

 Refunds given only when  cancellation is more than 72 hours prior to class date. Print and fill out form and send to address below

Send to:   Susan Ticken 1337 Fourth St. San Rafael, CA. 94901