Application to Register as a Pomegranate Guild Instructor

You may fill out this page online and print it or you may also print a blank form and fill in by hand. Return complete form to:

Barbara Rucket
1005 Ivy Falls Drive, NW
Atlanta, GA 30328
or email to Pomedu1@aol.com

Online form will automatically be emailed to Barbara and a copy sent to you for reference

Name
Address
City
State/Province
Zip/Postal Code
Home Phone	(with area code)
Email
Your own needlework/embroidery education:
Teaching experience:
Areas of specialization; topics you teach:
Fees/Honorarium:	$
How far will you travel?
Guild Member?	Yes No
Chapter Affiliation (if applicable)
Other Affiliation(s), Certifications:

Please feel free to duplicate and distribute this form.

Revised on June 23, 2003.