REGISTRATION FORM

September 12-16, 2021

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

NAME________________________________

ADDRESS_____________________________

CITY_________________________________

STATE & ZIP__________________________

HOME PHONE & CELL__________________

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EMAIL_______________________________

EMERGENCY CONTACT & PHONE

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LIST SPECIAL NEEDS (FOOD ALLERGIES ETC.)

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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