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Coastal
Maine Art Workshops |
REGISTRATION FORM
Name_______________________________________________________
Street or POB_______________________________________________
City/State/Zip________________________________________________
Billing & mailing addresses must match to process a
credit card
Phone (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 Classess x $260 Deposit for
each class..............$__________
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 #____________
MC/Visa/Disc/Amex - Credit Cd.#________________________________
Exp.Date________/__________3 digit code (on
back)______________
Name (Print)
______________________________________________
Signature________________________________________
Date______________________________________________________
Enrollment in a Workshop indicates your acceptance of
the terms set forth under Rates, Cancellation and Refund Policies.
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