NAME: _______________________________________________________________________________________________
(Please print your name above)
ADDRESS: ____________________________________________________________________________________________
PHONE (DAYTIME): __________________________ PHONE (EVENING): _______________________________________
EMAIL: ______________________________________ PHONE (CELL): ___________________________________________
$ 79
Payment is due by December 15, 2009
(Includes all entry fee's, lunch, lectures, transportation & gratuities)
.
_____ Adult
_____ Senior
Lunch Options:
_____ Regular Lunch
_____ Vegetarian Lunch
Please charge to: (please circle one) VISA MASTERCARD AMEX DISCOVER
Card Number: ___________________________________________________________ Exp. Date: ____________________________
Print Name as it appears on card: __________________________________________________________________________________
Signature Authorization:
_______________________________________________________________________________
When paying by check, please make check payable to ART Station, Inc.
Please return this completed form and payment to ART Station.
Our office hours are Tuesdays through Fridays, 10 – 5 and Saturdays, 10 – 3.
If your using a charge card, you may fax this form to us at 770-469-0355 or
mail your payment to ART Station, PO Box 1998, Stone Mountain, GA 30086.