Fallon & Wilkinson, LLC

Class Registration Form

Class title

Title

First and Last Name

 

 

Address
[Street]

[City, State & Zipcode]

 

Phone number

 

 

Email address

 

______________________________________

 

 I would like to receive updates in my email box periodically

 

 

Occupation

(optional)

 

 

Class experience

Other relevant experience/ interests

 

 

 

 

Tools
(may be required for some classes)

How did you

hear about us?

 

 

Cancellations are possible up to 5 days before the class with a full refund, save a $50 administrative fee.

Cancellations less than 5 days before the class cannot be accepted and will be charged in full

 

Please send this form with a check for the class registration fee in full to:

 

Fallon & Wilkinson, LLC

32 Bushnell Hollow Rd

Baltic, CT 06330

T/F: (860) 822 6790

info@fallonwilkinson.com  --  www.fallonwilkinson.com