Teacher Certification Registration Form
                                   
Location (City): _____________________ Class Date: __________________________

Name: _______________________________________________

Address: _____________________________________________

City: ___________________________________State: ________ Zip Code: _______________  

Phone:_____________________________ E-mail Address: __________________________________________

Is this your first certification with Sulky of America?: _______

Are you a National Traveling Educator for a sewing machine company?_______  

If so, which company? Babylock, Bernina, Brother, Elna, Janome, Pfaff, Singer, Viking

Will you be attending with a friend?: _________ Friend's Name ________________________________

Will you be staying at the hotel?: ___________

Do you have any food allergies?: ___________ List: ___________________________________________

A $100 non-refundable deposit is required at time of registration. Balance is due 3 weeks prior 
to training.  If you are mailing your registration and you wish to pay your $100 deposit or 
the full amount of $499.00 by credit card rather than by check, please complete the information 
below and return this form with your registration. For your convenience, if you pay your 
deposit by credit card we will also charge your card for the remaining balance 3 weeks before 
your training unless we receive your check for the balance before then. 
*Please be advised that the classroom is Non-smoking.

Circle Amount Paid:  $499-(In Full)   $100-(Deposit)       Circle one:  Corporate   Personal

Circle one:  M/C  VISA   Discover   Amex   Check           Circle one:  Debit   Credit

Card Number: ________________________________ Expiration Date: ____________ **Sec Code: ______
**For Visa, M/C, Discover, this is the 3 digits located after the acct# in the signature strip 
on the back of the card. For Amex, this is the 4 digit# above and to the right of the acct# 
on the front of the card.

Cardholder Signature: _____________________________________

Cardholder's Printed Name: ________________________________

Cardholder's billing address: ___________________________________________________________

Please mail or fax your completed form to:

Sulky of America, Inc. 
Attn. Teacher Certification
980 Cobb Place Blvd Suite 130
Kennesaw, GA  30144
Phone: 1-800-874-4115 Ext 161 OR 175
FAX: 1-770-429-3987