Longarm University Registration Form

 

Please print this form, fill it out completely and
send with your payment to:

 

Longarm University

12313 SE 198th Street

Renton, WA  98058

phone: 253-854-3362

fax: 253-854-0463


Please check our Policies regarding registration
before sending this form.

Student Information
Name _________________________________________________
Street Address: _________________________________________
City __________________________________ State _________
Zip or Postal Code ________________
Country:__________________
Email address: _________________________________________
Phone: ________________________________________________
What brand of machine do you have? _____________________
How long have you had your machine?____________________

Workshop / Class Information
Workshop Dates:________________________________________
Deposit $100 ____________Paid in Full $575 ________________

Payment Information

Total Amount: $____________________
Credit card: Visa _________ MasterCard ______ _______
Card # _______________________________________________
Expiration date: ___/___
Signature:______________________________________________
Check # ________________________