2019 ASOC Summer Art Experience Registration Form

Please register by 15 December 2018

Name:*
Membership Number:
PayPal Account Holder Name:*
Address:*
Phone:
-
Mobile:
E-mail:*
New member’s fee is $71.00; distance members (0ver 100k from Canberra) $49; students with ID $38

Workshops

Tutor            

Order of Preference

(1st or 2nd)

Choose only one option (1st preference) for payment

Pauline Adair                 

Workshop Full

To be placed on wait list please submit form with preferences but do not select a payment amount. Click on submit and form will be send directly to ASOC without directing you to PayPal.

Denis Clarke                  

Clarke:

Tracey Creighton              

Workshop Full

To be placed on wait list please submit form with preferences but do not select a payment amount. Click on submit and form will be send directly to ASOC without directing you to PayPal.

Jo Hollier  

Workshop Full

To be placed on wait list please submit form with preferences but do not select a payment amount. Click on submit and form will be send directly to ASOC without directing you to PayPal.

Lucy & Barry McCann           

Workshop Full

To be placed on wait list please submit form with preferences but do not select a payment amount. Click on submit and form will be send directly to ASOC without directing you to PayPal.

Carmel McCrow                   

McCrow:

Craig Penny                   

Penny:
Total:

Emergency Contact Information

Name of Emergency Contact:*
Special Requirements, i.e. Medical, disability. etc:
Special Dietary Requirements:
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.