Company Message - Company Message








For printable version of form click the link above


REGISTRATION FORM

July 16-21, 2017
(Arrive on Sunday, July 16   Classes July 17-21)
 
NAME________________________________
 
ADDRESS_____________________________
 
CITY_________________________________
 
STATE & ZIP__________________________
 
HOME PHONE & CELL__________________
_____________________________________
 
EMAIL_______________________________
 
EMERGENCY CONTACT & PHONE

_____________________________________
 
 
 
LIST SPECIAL NEEDS (FOOD ALLERGIES ETC.)

________________________________________
 
 
5 DAYS * M-F * July 17-21
1.________________________________________________
2.________________________________________________
3.________________________________________________
4.________________________________________________

2 DAYS* M-T * JULY 17-18
1.________________________________________________
2.________________________________________________

3 DAYS * W-F* JULY 19-21
1.________________________________________________
2.________________________________________________

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


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