CREATIVE ESCAPE WORKSHOPS REGISTRATION FORM
Please print and mail this form with payment to:
Creative Escape Workshops, 1489 Schaeffer Road, Sebastopol, CA 95472.
To pay by phone (707)824-1811
WORKSHOP TEACHER/ARTIST NAME: __________________________________
Workshop Dates_________________
Workshop location___________________________________________
Name: (Mr./Mrs./Ms.)________________________________________________________________
Address: ___________________________________________________________________________
CITY_______________________________________________________________________________
STATE______________ZIP____________________COUNTRY__________________________
Phone (home) ____________________________________________________________________
Phone (cell - so we can reach you on the road if necessary_________________________________
email___________________________________________________________________
I am enclosing Deposit only (50% tuition) Payment in full 2nd payment/ Final installment
Registration in a workshop indicates that you have read and accept the terms and conditions .
Payment
Check enclosed (payable to Carolyn Wilson/Creative Escape Workshops)
or
Authorization to charge my credit/debit card (Visa/Mastercard/Discover/American Express)
Card Number ________________________________ Expiration (month/yr)________________
CCV____ Authorization signature______________________________________ Date_________
or
Pay by phone - call (707)824-1811