Name:__________________________________________  Phone:__________________

Address:________________________________________________________________

City:_____________________________________________ State:_____ Zip:_________

    Class Date                  Class Description                                                  Cost

                                                                                                                         $                        

                                                                                                                         $                        

                                                                                                                         $                        

                                                                                                                         $                        

                                                                            TOTAL. . . . . . . . . . . . $______________

_________ Check Enclosed (made out to Merri Stitches, Inc.)

_________ Please charge my credit card (fill in below)

Credit Card: _____________________________________________________________

Credit Card #:____________________________________________________________ 

Exp. Date:        ___________________

Cardholder Signature: _____________________________________________________

Date:  ______________________