Enrollment Form Henry Isaacs Workshop September 5-7, 2008 Please print of type clearly NAME (Mr., Mrs., Ms.  ) _________________________________________________________ Nickname ___________________________________________________________________ ADDRESS ____________________________________________________________________ City _________________________________ State _______________ Zip ________________ Phone (________  ) ___________________________________ Email Address _______________________________________ Arrival Date _____/____/_____ Departure Date _____/_____/_____ (   ) PRIVATE ROOM, PRIVATE BATH (   ) PRIVATE ROOM, SHARED BATH (   ) SHARED ROOM, SHARED BATH, I will be sharing a room with _____________________________________________________ (   ) non-student (   ) fellow student (   ) PLEASE FIND ME A ROOMMATE I understand that if no roommate can be found, I will be enrolled at the single rate (   ) NON-PAINTING COMPANION (   ) DAY STUDENT (   ) ENCLOSED $375 DEPOSIT per person (   ) Check or money order (   ) VISA (   ) MASTERCARD __________________________________________________ Card Number                                              Expiration Date __________________________________________________ Signature                                                            Date (   ) Enrollment in the workshop indicates that you have read and understand the terms of enrollment. To print out this form: put your cursor anywhere on the page then 'right click'. Select 'Print' from the drop-down menu. Send to: Warm Springs Gallery 12 Katydid Trail Warm Springs, VA 24484 For additional information: Barbara Buhr 540.839.2985 e-mail: gallery7@tds.net Return to workshop information Page