Register

Adélie School of Protocol- Durham, NH  

1. Participant Name ____________________________________________ 

Address:______________________________city______________state____

email______________________________ phone/cell ______________________

 male____   female____      (if student please fill in grade _________)

 

If minor please fill out section 2 . 

2. Parent/Guardian Name ___________________________________ 

Address: _______________________________   City__________________

State______  Zip______        Phone/cell  __________________    

E-mail_______________________________________

 

Emergency Contact Name  ______________________________ 

Phone_______________

 

Class title:  _________________________                                                                

Investment cost:  ____               Date/ Time:___________ 

Location: _______________________________________ 

Requested Attire for Dining Classes: Female- dress, skirt or dress slacks.  Males- dress slacks, shirt & tie, optional suit jacket.

Please list dietary restrictions: ________________________________________________________________________

 ____ I authorize taking photos of (students name)__________________________ by  Adélie School of Protocol, LLC to be used solely for record, newsletter, or general media purposes (full name omitted).

 ____ Check here if you would prefer not to have student photographed. 

Name __________________________ 

Signature _______________________    Date_________

 

Enclose a check payable to: Armida Geiger. Mail completed form wtih payment to: Adélie School of Protocol, 13 Davis Avenue, Durham, NH 03824.

 

• You will receive a call to confirm reservation upon receipt of registration & payment.

• Partial refund requires a 24-hour cancellation prior to the class date.  For information please call Armida A. Geiger (603) 868-7156.

• Registration required 7-10 days prior to the class date.