Nelly's Sewing Box CyberWorkshop Mail-in Registration

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ANG Number:
First Name:	Last Name:
Address:
Apartment Number: (if applicable):
City:
State (or Province):
Zip (or Postal) Code:	Country:
Home Phone:	Work Phone:
e-Mail Address:
Payment Amount: _____ $146.00 for class fee, course booklet, and U.S. domestic postage. _____ $308.50 for class fee, course booklet, lacquer box and U.S. domestic postage. _____ $142.50 for class fee, course booklet, and Canadian postage. _____ $308.50 for class fee, course booklet, lacquer box and Canadian postage. _____ $163.00 for class fee, course booklet, and international postage. _____ $346.00 for class fee, course booklet, lacquer box and international postage. _________ Total Payment Due
Payment Method: _______ Check (enclosed with this form) _______ Charge my credit card MasterCard or Visa (circle one) Number: ________________________________________ Expiration Date: __________________________________ Signature:_______________________________________

To register, your membership must be current with ANG's national membership office. Check the mailing label of your most recent issue of Needle Pointers for your membership number and the expiration date. Your payment must accompany this form.

Payment can be made by check or by Visa or MasterCard. Please make checks out to ANG; please write your ANG membership number on your check.

All payments are final.

Mail the completed registration form and your payment to:

ANG CyberWorkshop
2810 Crossroads Drive, Suite 3800
Madison, WI   53718
Fax: 608-443-2474

Your completed registration form and payment must be postmarked or faxed by February 28, 2007.

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