Traial Application Form Atelier Flore

Application by FAX, please,print out this page,fill out the necessary information send
  I will contact you later.
Date of application 20   .   .     (  )
 Trial lesson  Prease fill in check in the hope lesson
 type  Fresh flower  Preserved    Flower Candle
  Type  Round ・ Theme of season  Green ・ Pink ・ Yellow   You can select color
 Cost  ¥2,500- all     ¥3,000- all    ¥2,500- all  
Hope date & time                             Other hope date
Experience Experience of arrangement Experience of candle
First  ・ Experienced  ・Ikebana  First time ・ Experienced 
Furigana    Date of birth
Name               ・     ・  
Pohne       ー   -      Mobile phone       -     -       
Other requests  

 1Day lesson Prease fill in check in the hope lesson
 Type Flower candle  Herbarium
Type  Your choise (            )  Slim glass bottles large and small
 Cost  By content of works  ¥4,500- all 
Hope date & time                           Other hope date
Experience    Flower candle Herbarium
First  ・ Experienced  First  ・ Experienced 
Furigana    Date of birth
Adress 〒   
Pohne ー    -    Mobile phone    -     -
E-mail  @ 
Other requests   

 FAX  03-3965-2635

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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.

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.

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