Registration Form 2010

Mosaic Intensive Workshop (5 Days - 40 hours)

Your Name
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Birthday	MMDDYYYY
Address
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YEAR 2010

Please check the class you like to take:

	Jan 11-15, 2010
	Jan 18-22, 2010
	Feb 8-12, 2010
	Feb 15-22, 2010
	Mar 1-5, 2010
	Mar 15-19, 2010
	Mar 29 - Apr 2, 2010
	Apr 12-16, 2010
	Apr 19-23, 2010
	May 10-14, 2010
	May 17-21, 2010
	May 24-28, 2010
	Jun 7-11, 2010
	Jun 14-18, 2010
	Jun 28 - Jul 2, 2010
	Jul 12-16, 2010
	Jul 26-30, 2010
	Aug 23-27, 2010
	Aug 30 - Sep 3, 2010
	Sep 6-10, 2010
	Sep 20-24, 2010
	Sep 27 - Oct 1, 2010
	Oct 4-8, 2010
	Oct 18-22, 2010
	Oct 25-29, 2010
	Nov 8-12, 2010
	Nov 15-19, 2010
	Nov 29 - Dec 3, 2010
	Dec 13-17, 2010

I'm not sure I can attend your class. Please hold a space for me only for 15 days.
I'm very interested in attending your class. Please reserve a space for me.

Further questions, requests or notes :

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please email your request of enrollment to: info @ mosaicschool.com
or via fax : (+39) 0544 67061

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