Painting Class Registration Form
Student Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
example@example.com
Mobile Number
Additional Comments
Artwork Options
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Door Hanger #1
Round "Welcome" Door Hanger
$
35.00
Quantity
0
1
2
3
4
5
Door Hanger #2
Cross Door Hanger
$
35.00
Quantity
0
1
2
3
4
5
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Submit Application
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