Adult Registration Form
First Name
MI
Last Name
Home Address
Street
City
Zip
Home Phone
Work/Cell Phone
Email
Mailing list ok?
Yes No
Please select a class
Please Select A Class workshops for adults Summer 2008 create with clay for adults
Then a date
Emergency contact info:
First Person
Relationship
Contact Number
Second Person
Medical Insurance Carrier:
Policy Number
Phone Number
What is your art experience and interests?
Where did you hear about EAS?
*A 25. deposit is required to reserve a space for the class; the balance is due at the end of class. Thank you!
