Register

Please submit this application with your deposit to reserve your seat in the seminar. Personal check, money order and Visa or MasterCard accepted.

Questions? Call 510-490-0379.

*(denotes required field)

Name: *

E-Mail Address: *

Address

City, State, Zip

Phone

Alternate Phone

Class Dates,Friday & Saturday, February 17 & 18 *

Special Dietary Needs
We want you to feel right at home.
Please include food and beverage preferences as well.

Tell us about yourself
Any decorating experience?
Why would you like to take this class?

Emergency contact (name and contact information)

How did you hear about this course?

--please select -- Referred by someone who took the course Found the website by search engine Met Anna in person IRIS member referral or IRIS website Other (please specivy)

If "Other" please specify

Method of payment

Check
Money Order
Credit Card

If paying by credit card, please call Anna at 510-490-0379 for a secure credit card transaction

By checking this box, I agree to the Anna Jacoby Interiors terms and conditions *

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