What workshop are you registering for?

Name of workshop?

 

Date of workshop?

Cost of workshop:

 

Tell us how to get in touch with you:

Name
E-mail
Tel
Address
Amount enclosed
Or: Credit Card Type: Visa or MasterCard
Credit Card Number
Credit Card Expiration Date
Name on Credit Card:
Amount to be credited
Please include your full name, address and telephone number above that is attached to this credit card.
Name
E-mail
Tel
Address
Amount enclosed

How did you hear about us?

Please contact me as soon as possible regarding this matter.

Please print this form. Send payment, made payable to Mary Gravelle, to:

Wisdom Painting and Art
268 Oak St.
Manchester, CT 06040 

In addition to filling out this form, please call us at (860) 649-9701 to confirm.