Registration Form

Mail to: 5425 Southside Dr., Amarillo, TX  79109
By:  November 1, 2003  (If your payment is received after class is filled, it will be returned.)

__________________________________________________________
Name (print)

__________________________________________________________
Mailing address

_________________________    ___________    _______________
                        City                                      State                         Zip

__________________________________
 Email

Please enclose check, money order, or credit card information:
(No cash please.)
 __ $25 deposit enclosed (Balance of $200 is due first day of workshop)

Card no._____________________________________Exp. date______/______
__Master Card      __Visa
Signature_________________________________________________________

What medium will you use?
 __Oil      __Pastel     __Other ________
What is your portrait experience level?
 __Beginner      __Intermediate      __Advanced
What do you most want to learn from this workshop?
______________________________________________
______________________________________________

Lincoln Schoolhouse Gallery and Art Center
P.O. Box 115
Hwy. 380, Lincoln, New Mexico
(505) 653-4934
Fax: (505) 653-4539

kelly@LincolnSchoolhouseGallery.com
Copyright 2003 - Lincoln Schoolhouse Gallery