test

ASOC 2018 Summer Art Experience Registration Form
Form for registering for 2018 Summer Art Experience
Name:*
Address:*
Phone:
-
Mobile:
E-mail:*
New member’s fee is $71.00; distance members (0ver 100k from Canberra) $49; students with ID $38

Master Classes  (Advanced Only)

Tutor            

Order of Preference

(1st or 2nd)

ASOC Member

           $

Non Member

          $

Enter and Pay for 1st Preference Cost Only

Herman Pekel            

600           

700           

  

David Wells           

750           

850           

  

Heidi Willis           

750           

850           

  

Standard Classes

Tutor            

Order of Preference

(1st or 2nd)

ASOC Member

           $

Non Member

          $

Enter and Pay for 1st Preference Cost Only

Pauline Adair

725            

825            

  

Christopher Blake

650            

750            

  

Denis Clarke

650            

750            

  

Rick Cochrane

746            

846            

  

Chan Dissanayake

650            

750            

  

Angelika Erbsland

665            

765            

  

Chris McClelland

650

750

  

Tracey Miller

650            

750            

  

Gary Myers

650            

750            

  

Craig Penny

650            

750            

  
Total:

Emergency Contact Information

Name of Emergency Contact:
Special Requirements, i.e. Medical, disability. etc:
Contact Phone Number:

By clicking on this button you will be submitting your form electronically and at the same time directed to Paypal to make your payment. When the payment has been made click on Return to Vendor to get your confirmation message.

.footer-widgets { padding: 20px 0; }