Name ___________________________________________________________________________
Mailing Address___________________________________________________________________
City-State/province_________________________________________________________________
Phone___________________Fax__________________________Email______________________
Your Website address (if applicable)__________________________________________________
Workshop Name__________________________________________________________________
Workshop Dates__________________________________________________________________
I will be staying at (Hotel name) ______________________________________________________
(other contact)____________________________________________________________________
Medium I work in Oil_____WC_______other______
Level Amateur_______Intermediate__________Advanced____________
Deposit enclosed ______ck______MO________
Amount in US Funds enclosed______________________Date_______________
Balance must be received 30 days prior to start date of workshop.