PURPLE FLEECE

Class Registration

Name: _______________________________________________________

Address: _____________________________________________________

City/State/Zip: ______________________________________________

Phone Number: ________________________________________________

Email: _______________________________________________________

Class: _______________________________________________________

Dates: (must be pre-arranged with Purple Fleece) _____________________________________________

Due to the nature of private instruction, a non-refundable $25.00 deposit is required 
with this registration form. If you have also reserved B&B for the duration of your class, 
please include an additional check for $35.00. 

Please make checks payable to Deborah Bergman and remit to:
	Purple Fleece
	103 School Street
	Stockton Springs, ME 04981