REGISTRATION FORM FOR ADULT POTTERY CLASSES @ TPG                                               (PLEASE PRINT and mail or deliver with payment) NAME:         ___________________________________________________     ADDRESS:   ___________________________________________________                                           POTTERY CLASSES   STATE:         __________________     ZIP:  ___________________________                                 TOLEDO POTTERS’ GUILD   DAYTIME PHONE:   ____________________________________________                                         5403 ELMER DRIVE   EVE./OTHER PHONE:   ____________________________________________                                     TOLEDO, OHIO  43615   E-MAIL ADDRESS: ____________________________________________   TEN WEEK SESSION:  (circle)           Fall (begins 9/14/10)           Winter  ( TBA)          Spring   (4/5/10)           Summer (6/15/10)   CHOICE OF CLASS NIGHT:  (circle)   Tuesday – 6:30 pm-9:00pm  (Johnston)                                                               Thursday – 6:30pm-9:00pm (Savino)                                                                   (If other sections fill) -- Monday  6:30pm-9:00pm   (Instructor varies)   WHAT OTHER EVENINGS WOULD BE POSSIBLE ALTERNATIVES FOR YOU as a second choice?                                                                                                                       _________________________________________         FEE OPTIONS:  (circle)    Fees include 10 sessions, all materials and firings and the first #25 of clay.   OPTION #                                             TUITION           SUPPLY FEE          CLAY FEE             TOOL FEE             TOTAL PAYMENT DUE   1 (FIRST TIME STUDENT)                    $135.00                 $20.00                   $8.00                     $12.00                                 $175.00   2 (RETURNING STUDENT)                   $135.00                 $20.00                   $8.00                       N/A                                    $163.00   3 (GUILD MEMBER)                              $121.50                 $20.00                   $8.00                       N/A                                    $149.50   METHOD OF PAYMENT:  (circle)             CHECK (MADE PAYABLE TO TPG)          MASTERCARD               VISA               DISCOVER   CARDHOLDER’S NAME:  (print)  __________________________________________________________________________________   CARD NUMBER:  _____________________________________________________     EXPIRY:  _______________________________   TOTAL AMT. TO BE CHARGED:  $ _______________       CARDHOLDER’S SIGNATURE:  ___________________________________ BY SIGNING THE BOTTOM OF THIS FORM, I AFFIRM THAT I HAVE READ THE TPG BEGINNING POTTERY CLASS INFORMATION     PUBLISHED WITH THIS REGISTRATION FORM.  FURTHERMORE, I AGREE TO ACCEPT THE STATED TERMS AND CONDITIONS  FOR PARTICIPATION IN THE CLASS, INCLUDING INSTRUCTIONAL OFFERINGS AND CLASS PAYMENTS.  CLASS FEES WILL BE REFUNDED TO ONLY THOSE INDIVIDUALS WHO WITHDRAW PRIOR TO THE FIRST CLASS SESSION, OR IF A CLASS SECTION IS CANCELLED DUE TO INSUFFICIENT ENROLLMENT.     SIGNATURE:  (indicating acceptance of terms)  ____________________________________________     DATE: _______________________                                       Mail or hand deliver this completed registration form along with your payment.              If mailing, please send to the address noted above; envelope must be postmarked no later than 6 days before the first class.