REGISTRATION FORM

I wish to attend the Mosaic Workshop weekend course understand that the fee includes instruction and a limited selection of

materials. Mosaic Workshop or its agents will not be liable for any accidents or injury suffered by me or damage to my property

whilst on Mosaic Workshop premises.

  I enclose a cheque/postal orders for £          in payment of the course fee (made out to EMMA BIGGS). I understand that in

the event of the courses being fully booked when my payment is received it will be returned in full.

Cancellation: If I cancel or move my course place within 7 days of the course I will be subject to a cancellation fee of £25.

Name_________________________________________________________                                                                          

Address____________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

E-mail Address ___________________________________________

Telephone:     Home ____________________________           Work____________________________________

Please fill in the dates and title of the course you wish to attend:- 

______________________ _______________________________________

I will switch courses if my preferred dates are unavailable.

Please circle your answer:       Yes       No

Signature                                                                                     Date                           

NB Mosaic Workshop reserves the right to cancel any course and refund your payment in full.

Please complete and send this form to:

Mosaic Workshop
Unit B 443-449 Holloway Road
London N7 6LJ