Arts Benicia Education Program Registration Form

Name

Address 

City
Home Phone 
Work Phone
E-Mail

Workshops and Classes

Class Cost:
 Class Description and Date:
   
   
   

To pay with Visa or Mastercard (sorry, American Express and Discover not accepted):

Card Type

 Visa       Mastercard  

Credit Card Number

Security number (on back of card)

Expiration Date

Amount Due

$

Name on Card

Please make Checks or Money Orders payable to "Arts Benicia"

Comment or Question:

Please complete the information, and mail to:

Arts Benicia P.O. Box 157, Benicia, CA  94510 or fax to: (707) 747- 0241