Women In Art Course Registration and Payment Form

Women In Art Course Registration and Payment Form

February 25th, March 4th, March 11th, March 18th, March 25th, April 1st
Student Name*

First NameMiddle NameLast Name Anan
Birth Date*

MonthDayYear
Student Name (include preferred pronoun after First Name)*

First NameMiddle NameLast Name Anan
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
Phone Number
Format: (000) 000-0000.
Profession
Courses
Course Cost - £150 / Sliding Scale Option Available To Support Inclusion £60-£140
Course must be paid in full.
Should be Empty: