Murano : Fax Registration Form

Murano Restaurant
Course Registration Form

Please print out and fill in the following form. You can fax it to the restaurant at 519-438-7471 or return it directly to: Murano Restaurant 394 Waterloo Street London, Ontario, N6B 2N8

Name

Phone Number	Email

Course Name	Date of course

Method of payment (Cash, Credit card, Cheque)	Credit card type(Visa, Mastercard, American Express)

Credit card number	Credit card expiration date



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