Name *

First Name

Last Name

Date *

MM

DD

YYYY

In Case of Mishap *

In the very rare circumstance that your piece breaks or cracks in the firing process, please specify your preferred solution:

I would like a full refund from this class

I would like a free future class

Phone *

(###)

###

####

Do you need your piece shipped?

Yes

No

If yes, please provide your shipping address:

And pay $15 for shipping/handling charges with your instructor at the front desk

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country