Name:

Business Name (if applicable):

Mailing Address:

Phone Number:

Email Address:

Website (if applicable):

Professional Qualifications:

Course Title:

Course Description:

Age Group for class (if class is geared for children, please specify ages):

Estimated Cost of Supplies Needed:

Class Size (maximum number of students):

Preferred Class Day:

What type of class is this?

One-time class  Class series (4-6 weeks) 

Preferred Class Time:

How long does each class last? (1 hour, 2 hours, etc...)