Puget Salish Language Classes

 

Course Title: _________________________________________________________

Quarter: ___Winter, ____ Spring, ____ Summer, ____ Fall Year: ______

 

Student's Name:______________________________________________________

Street Address:______________________________________________________

City/State/Zip code: ___________________________________________________

Work Telephone: _______________________ Home Telephone: _______________

E-mail: _____________________________________________________________

 

Payment Method: Check:__ or Cash:__ Amount:_________

(Make checks out to Zahir Consulting Services)

Payment is attached:__ or Payment will be made on the first day of class: ______

 

Signature: ______________________________________________________

 

Mail or fax Registration Form to Zalmai Zahir @: P.O. Box 54213, Redondo, Washington 98054

fax: (253) 529-7297 

Zahir Consulting Services - P.O. Box 54213, Redondo Wa 98054 - (253) 529-7296 (Ph.) - (253)709-3798 (Cell) - (253) 529-7297 (fax)