REGISTRATION FORM

September 12-16, 2021


(Arrive on Sunday, Sept. 12 Classes Sept. 13-16)


NAME________________________________


ADDRESS_____________________________


CITY_________________________________


STATE & ZIP__________________________


HOME PHONE & CELL__________________

____________________________________


EMAIL_______________________________


EMERGENCY CONTACT & PHONE


_____________________________________


LIST SPECIAL NEEDS (FOOD ALLERGIES ETC.)


________________________________________


4 DAYS * M-T* Sept. 13-16

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

0