ANG: American Needlepoint Guild - Correspondence Course Registration Form

ANG Correspondence Course Registration Form

PLEASE PRINT CLEARLY

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Name of individual registrant or group secretary:
ANG Member # if possible, please enclose a copy of the label from a recent issue of Needle Pointers
Address:
Apartment Number: (if applicable):
City, State (or Province):
Zip (or Postal) Code:	E-mail address:
Home Phone:	Work Phone:

Individual registration for the person named above:

Course:

Teaching Fee:

$ 45

Teacher:

Registration Fee:

$ 15

Color/ground fabric choice for kit (if applicable):

Kit fee (if applicable):

$ ___________

Additional postage for non-US students**:

Non-US Postage::

$ ___________

Total fees:

$ ___________

Group registration (group secretary listed above):

Name of Group (chapter name or other):

Members of Group: List below. Attach a separate sheet of paper if necessary.

Name	ANG#	Color choice for kit (if applicable)

Teaching fee:	$ 45	X	______ (no. of students)	=	$ ________
Registration fee:					$ 50
Kit fee (if applicable):	$ ________	X	______ (no. of students)	=	$ ________
Non-US postage**:	$ ________	X	______ (no. of students)	=	$ ________
			Total Fee:	=	$ ________

Payment:

Check enclosed payable to ANG for all fees (individual or group registrations)
Visa MasterCard (individual registrations only)

Name on card:	Card Number:
Signature:	Credit Card Expiration:

Send payment to:
Enrollments - Correspondence Courses
2810 Crossroads Drive, Ste. 3800
Madison, WI 53718
Fax for Credit Card Orders: 608-443-2478
E-mail: ccregistrar@needlepoint.org

** Additional postage charges for non-U.S. students:
$5 per student for instructions only;
$10 for each student receiving instructions and full or partial kit.