UVA Experience Art Registration Form

Experience Art Registration Form
Please register one week prior to your class to insure your place.

Please fill out the form completely and mail, with your check or credit card information, to:
Upper Valley Arts
P.O. Box 754
Leavenworth, WA 98826

Name (Must be 18 years or older to register) ___________________________________
Address _____________________________________
City State Zip __________________________________
Phone _____________________________
E-mail _____________________________

Number Course Title Tuition Materials fee

___________________________________________________________

TOTAL $_________________._________

Payment (select one): ____Check (enclosed payable to Upper Valley Arts)
Credit Card Select one: ____ Visa ____ Mastercard
#________________________________________ Exp. Date__________

Authorized Signature__________________________________________

Phone authorization via number (______)_________________________

Send this form with payment to: Upper Valley Arts, P.O. Box 754, Leavenworth, WA 98826