Please print out the form, fill it out and mail it to:  
Ghossein Museum
7708-190 street.
Edmonton, Alberta, Canada
T5T 5H8                                                                                                    

                                                                                                                          No.:

                      Registration Form


Course Number:
First Name:                                                 Last Name:
Mailing address:

Phone:
Fax:
E-mail:
Fees: method of payment Visa, Master Card, Cheque, Cash.
Credit Card Number:                                                                Expiration date:
Required books?
Rocks & Minerals $39 CDN  
Gems & Precious stones $39 CDN
Would you like Rock and/or Mineral samples?
Final Exam: Yes(    )       No (       ).


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Office use only                                                        FE:
Registration #
Fees:
Books & Samples
Date lectures and/or material sent:
Registration