|
2010
May 23--29, 2010 All registration
forms must be accompanied by a $100.00 Registration or your full tuition
payment (Registration pmt. will be applied to tuition). You may pay by check,
Master Card / Visa. Please make
Cks payable to Tom Johnson. and put PASS in the Memo section of your
check. FULL TUITION MUST BE RECEIVED BY MARCH 1, 2010 COMPLETE THIS FORM,
ATTACH YOUR PAYMENT AND MAILTO: |
Name:
_________________________________________________________________________________________________
Address:
_______________________________________________________________________________________________
City:
_________________________________ State: __________ Country:____________
Zip/Postal Code:______________
Tel:
_________________________ Fax:______________________
Cell:________________________
E-mail: ____________________________________________________________________________
□ Private Bedroom □ Share a Bedroom with:
___________________________________________
□ Share a Suite with:
___________________________________________________________________________________
□
Rent linen - □
Rent
a phone - □ I will drive to
Charleston - □
I will be a Day Student (Not staying in the
Dormitory)
PLEASE CHECK THE APPROPRIATE BOXES BELOW:
|
6 Day Class – May 24 – 29 (Check in May 23rd) |
6 Day Class – May 24 – 29 (Check in May 23rd) |
|
□
Ivonne Planos . Box or Vase |
□ San Do ……. Portrait: Pretty Lady |
|
First 3 Day Class: May 24, 25, 26 |
Second 3 Day Class: May 27,28,29 |
|
□ Filipe
Pereira ……….. Animals |
□
Filipe Pereira ………… Animals |
|
□ Peggy
Harrup ………… Poppies |
□
Peggy Harrup ………. Wild Roses |
|
□
Rickie Nishi ………… Fruit |
□
Rickie Nishi …………. Flowers |
|
□ Alzora Zaremba ……. Peacocks |
□ Alzora Zaremba …… Waterfall |
EMERGENCY CONTACT:
Name: _______________________________________________
Tel: ______________________________ Work
Tel: _______________________________ Cell:_____________________________
Relationship: _________________________________ ALSO: Use a separate piece of paper to describe any medical condition we need to be aware of (held in confidence). Include all allergies.
Please
fill in blanks and sign the following: On this the ____ day of ____,
2010, I _______________________________________
agree that I will not hold The College of Charleston, its employees, PAS-South and its staff responsible for any
loss of or damage
to my person or personal property while attending the PAS-South classes. I
further agree to hold the College of Charleston and
PAS-South and its staff harmless from any and all suits or claims resulting
from the activities while en route to and from the PAS-
South school or during my participation in the PAS-South school or any
school activities. My check #
_________ for $_________
is enclosed. If paying by credit card please complete the following:
(Please
type or print): Name as it appears on credit card:_________________________________________________________________________
MASTER CARD
or VISA #:
_______________________________________________________________________
Exp Date:_______________
Your
Signature:____________________________________________________________________________________________________
