Date Night Pottery

REGISTRATION FORM

NAME: _________________________________________________________________

CHILD’S NAME: _____________________________________________AGE__________

ADDRESS: ________________________________________________________________

C/S/Z:___________________________________________________________________

PHONE (H): _______________________________(W):__________________________

E-MAIL:_________________________________________________________________

$79 per couple

ART Station Member?                        YES          NO   (See membership info below)

____Enclosed is my check #_____________ for $_____________

(Make checks payable to ART Station.)

____Please charge my  VISA   AMEX  MC   DISC $______________

                                               (circle one)

Card#:____________________________________________________Exp.Date:_________

Signature: ________________________________________________________________

Return to: ART Station/P.O. Box 1998/Stone Mountain, GA 30086

Fax: 770 469 0355/E-Mail: info@artstation.org

No refunds or make-ups will be given for missed classes.

Classes require a minimum of 8 students

QUESTIONS?

(770) 469-1105 OR info@artstation.org.