info@CoastalMaineArtWorkshops.com

REGISTRATION FORM
Please print this form, fill it out and mail to the above address
remember to include your deposit

Name_______________________________________________

Address_____________________________________________

___________________________________________________

City_________________________ State_____ Zip__________

Phone _______________

E-mail______________________________________________

Contact preference: ___ phone ___ e-mail

Do you require lodging? __ Yes ___ No
If you require lodging, you are responsible for making your
reservations - please read the enclosed lodging information

Special needs? ( if so please explain below)
___________________________________________________

___________________________________________________

___________________________________________________


Menu choice for the Monday’s complimenary dinner
__lobster __ vegetarian __beef __chicken


you may bring guests to the dinner for an additional charge
of $25 per person
 

please indicate the workshop(s) you are attending

__ Workshop #1 Steve Rogers (5 days for $450)
.
__ Workshop#2 Ted Skowronski (4 days for $360)

__ Workshop #3 Peter Spartaro (4 days for $360)

__ Workshop #4 Judi Wagner (5 days for $450)

__ Workshop #5 S. Hollerback (5 days for $450)

__ Workshop #6 Ratindra Das (5 days for $450)

__ Workshop #7 Ned Mueller (5 days for $450)

__ Workshop #8 Wilson Ong (5 days for $450)

__ Workshop #9 Bill Vrscak (5 days for $450)

__ Workshop #10 Paul George (5 days for $450)

__ Workshop #11 Don Getz (5 days for $450)

# of workshops x $250 deposit ...............$_________
# of dinner guests @ $25 per person $ _________
TOTAL DEPOSIT ENCLOSED $ __________

Payment is by:
__Check __ Money order (#______________________)

__ Credit card(#_________________________________)
MasterCard. Visa, Discover, American Express
Expiration date (MM/YY) ____/_____ digit code ______
(3 digit security code located on back of card near signature)

Name on card ___________________________________

Signature _______________________________________

Date ________________
your billing address and home address must be the same in order to process the credit card

Enrollment in a workshop indicates that you have read and
agreed to the terms of registrations set forth under
Workshop Rates, Cancellation and Refund Policies and Lodging Rates.