WORKSHOP REGISTRATION FORM

To check on class availability, please call the studio at 804-358-2771.  Thank you!

WORKSHOP:_______________________________________________

NAME: ____________________________________________________

ADDRESS: _________________________________________________

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PHONE: _______________ EMAIL: _______________________

METHOD OF PAYMENT: ( ) Check -- Made payable to Brazier Studio, Inc.

( )Name on Credit Card: __________________________Visa ___ M/C ___ AmEx___

Credit Card #: _______________________________________Expiration Date: ____

Signature: ______________________________________________________________

Why do you want to take this course and what do you hope to experience?_________________________________________________________________

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Please send completed application AND workshop fee to: Brazier Studio, Inc., 1616 W. Main St, Richmond, VA 23220. The non-refundable fee for each workshop must accompany the completed registration form.