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