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For printable version of form click the link above

REGISTRATION FORM

September 13-17, 2020


(Arrive on Sunday, Sept. 13 Classes Sept. 14-17)


NAME________________________________


ADDRESS_____________________________


CITY_________________________________


STATE & ZIP__________________________


HOME PHONE & CELL__________________

____________________________________


EMAIL_______________________________


EMERGENCY CONTACT & PHONE


_____________________________________


LIST SPECIAL NEEDS (FOOD ALLERGIES ETC.)


________________________________________


4 DAYS * M-T* Sept. 14-17

1.________________________________________________

2.________________________________________________

3.________________________________________________

4.________________________________________________




Make Checks Payable to:

PORCELAIN ART SCHOOL OF INDIANA

Send $75 non-refundable deposit

(or full tuition) and this registration form to:

CAROLYN JUNG

4301 E CR 150 N

AVON, IN 46123