Registration
Form

Name  Street City    State Zip Phone (H) (W) Email   Child’s Age (if under 18)   Parent’s Name Parent’s Address (if different from above) Parent’s Place of Employment

Are you a member? Yes No Joining Renewing   Membership level Select one Student/Senior/Regional – $35 per year Individual – $50 per year Household – $80 per year Friend – $100 per year Patron Circle – $250 per year 365 Circle – $365 per year Studio Circle – $500 per year Gallery Circle – $1,000 per year Collectors Circle – $3,000 per year Founders Circle – $5,000 per year Cornerstone Society – $10,000 per year

Class Title / Section / Dates        $ $ $ $ $

                                             Total Payment $

My check, made payable to the Hand Workshop Art Center, is enclosed.

Charge to my: Discover Master Card Visa American Express Card # Exp. Date

Signature:

Notice:
Photographers are often on the premises during classes and special events to capture images for the Hand Workshop Art Center’s Archives and for use in publicity materials. If you prefer not to have your photo taken for such purposes, please check the box: