The home of Mosaic Madness and Art for Strictly Beginners

Has now become nolastudio. I would love you to go there now to truly experience nola and her creative website

Course Application Form

  

All you need to do is complete this form and forward your payment by fax, phone or post. Please make cheques or money orders payable to Mosaic Madness. A Tax Invoice/Receipt will be available for collection at the first workshop.

  

 Section 1 — Your Details
Name:
Address:
Postcode:
Phone:
BH  
AH  
Mobile
   
Email:
 
 
Confirm Email:
 
 
This is for a gift voucher
  Who would you like the gift voucher
made out to?
 
  Where would you like us to post the
gift voucher to?

(Write 'as above'
if you would like us to use your address)
I would like to subscribe to the Madness Newsletter. I am interested in: 
Art
 Shopping
Mosaics
 Empowerment
St Gerasimos Community Mosaic Project
 Section 2 — Courses
 Course Title Preferred Date Cost (inc GST)
Total: $
 Section 3— Payment
Total Amount Payable:
$
Payment Method: Cheque Money order
Please make cheques or money orders payable to Mosaic Madness
[Visa] [Mastercard] [Bankcard]

Your privacy and security is important to us, please print a copy of this form and complete this part offline. You may Post, phone or fax this section through.

v This section to complete offline v

Card No:
Name on Card:
Expiry Date:
   
Cardholder address:
Charge Amount ($):
 
Signature:

^ This section to complete offline ^

PRINT a copy
and
forward with payment to:

rear 747 Darling Street, Rozelle NSW 2039
ABN: 1282 5566 718

or Fax to: (02) 9818-7472

 

 

 

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