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POB 845 Camden, ME 04843
207-594-4813 (fax) 207-596-6492
info@coastalmaineartworkshops.com
www.coastalmaineartworkshops.com

PLEASE USE YOUR PRINTER
TO PRINT OUT THIS REGISTRATION FORM

Name____________________________
St. or POB_______________________
City/St./Zip________________________
Billing & mailing addresses must match to process your credit card
Ph: (H)___________(W or C?)___________
Email____________________________
You MUST make your own lodging reservations.

Class____________________Fee…$____
Class____________________Fee…$____
Doing more than two?? Add another sheet of paper.
Total amount due………………………...$____
# of Classes x $260 Dep. for ea. class…$_____
TOTAL AMOUNT ENCLOSED…………..$_____
Balance due 45 days prior to class (unless otherwise indicated) (We will bill your credit card automatically on this date)
Payment: Check #______ ____ Credit Card___
MasterCard/Visa/Discover/American Express
Credit Cd. #________________________
Exp.Date_____/_____Auth. code on back____
Name (Print) on Card _______________________
Signature__________________________
Date submitted______________________
Enrollment in a Workshop indicates your acceptance of the terms set forth under Rates, Cancellation and Refund Policies.