WORKSHOP REGISTRATION FORM

NAME OF WORKSHOP INSTRUCTOR: _____________________________________

DATE OF WORKSHOP: __________________________________________________

NAME: _________________________________________________________________

ADDRESS: _____________________________________________________________

DAY TIME PHONE: _____________________EVENING PHONE:________________

EMAIL ADDRESS: ______________________________________________________

WORKSHOP FEE: _______________________________________________________

Note:  You may pay half the amount of the workshop fee to reserve a space. 
The last half will be received one month from the date of the beginning of the class.

Please check the following options and fill out the necessary information:

I am enclosing a check _________

I am paying by Visa Card _____ I am paying my Master Card:_____

My card number is: _________________________________Expiration Date:_________

Cancellation Policy:  If the class doesn’t have the required minimum of students,
TPAPS will refund all your money.  If you should choose to cancel, you will not be
 given a refund but the funds will be put toward another TPAPS workshop of your choosing.

Indemnification Claus:  I agree to indemnify the Tucson Plein Air Painters’ Society,
its teachers and administrators and members for any costs or liabilities which
they may incur as a result of my participation in the field workshop described above.

___________________________________________                       _________________

Workshop participant signature                                                           Date

Student Information:  A supply list and other pertinent information will be mailed to
you one month before the start of class.

Mail this form to:  TPAPS WORKSHOP

                               C/O Judith D’Agostino

                               3756 West Morgan Road

                               Tucson, Arizona 85745

You may reach Judith at Judith@judithdagostino.com if you have questions.