Aapplicatio form  for Admission Ateria Flore

Please If you are applying for by FAX, print out this page, fill out the necessary information send       we will contact you later.
Date of application  20   ・   ・  (  )
Furigana   Date of birth
Name           ・      ・    
  If you do not mind, please fill it out
Sex man     ・     woman ✓ Please do it
Phone          -       - Mobile phone     -      -
Hope course

✓ Please do it
Flesh flower Qualification course Hobby ( petit-flower ) course
Preserved Qualification course  Hobby course
Group lesson  Please fill in the name of the representative
Hope day ( Tues )  ・  ( Thurs )  ・  ( Sat )     It is possible to transfer it.
Experience of    arrangement Beginner  ・ Experiennce ・  Ikebana ✓ Please do it
Trial lesson Hope  ・  Not hope ✓ Please do it
About the handling of the personal information

 1 We will use your private information,either whole or part,only for the purposes as follow.

        ・To send the material inquired.
        ・To fill the formalities for the course.
        ・To contact new courses and the gidance of events

 2 Without pre-consentfrom you, we shall not use your private informations out of the purpose allowed or beyond that original intention.

 3 Your private information is not let out unless the case may be anyone of the followings.
        ・Your partly agrees wiyh it.
        ・Disclosure of the said information is legally required.
Copyright  2008(C) Atelier Flora All Rights Reserved.
無料 アクセス解析