THE CORNING MUSEUM O F GLASS
THE CORNING MUSEUM O F GLASS
THE CORNING MUSEUM O F GLASS
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FALL 2011/WINTER 2012 APPLICATION<br />
PAYMENT CHART FOR WINTER COURSES:<br />
Course Length Tuition Room & Board Additional charges<br />
for single room<br />
(subject to availability)<br />
One week $750.00 $520.00 + sales tax $320.00 + sales tax<br />
= $561.60<br />
= $345.60<br />
Please complete this application form and mail it to The Studio of The Corning Museum of Glass, One<br />
Museum Way, Corning, NY 14830-2253. Applications made by credit card may be faxed to 607.438.5150.<br />
There is no application fee for fall classes. Please include a $20 non-refundable application fee for one<br />
or two winter courses. Use a separate application form and enclose a $20 non-refundable application fee<br />
for each two additional winter courses.<br />
Name ________________________________________________________________________________________<br />
Address ______________________________________________________________________________________<br />
City _________________________________________ State ___________ ZIP Code ____________________<br />
Country ____________________________ Email ___________________________________________________<br />
Home # ________________________ Work # _______________________ Fax # _______________________<br />
COURSE SELECTION<br />
First Choice (include session #) _________________________________________________________________<br />
Fall Winter Date __________________ Instructor ______________________________________<br />
Second Choice (include session #) ______________________________________________________________<br />
Fall Winter Date __________________ Instructor ______________________________________<br />
I would like to take both courses.<br />
If a course(s) is (are) filled, please place me on a waiting list.<br />
WINTER PROGRAM ONLY<br />
I would like housing. I am Male Female Age: ___________.<br />
I am attending with _______________________________________ and we wish to room together.<br />
I would like a single room ($320 + sales tax = $345.60 extra per week. Availability not guaranteed.)<br />
METHOD OF PAYMENT<br />
Enclosed is a money order in the amount of $___________________.<br />
Enclosed is a check payable to The Corning Museum of Glass in the amount of $ ___________________.<br />
Please charge to: MasterCard Visa Discover American Express<br />
Application fee<br />
(non-refundable)<br />
$20.00<br />
Name as it appears on card _____________________________________________________________________<br />
Card number _____________________________________________ Expiration date ____________________<br />
If you check this box, we will charge your tuition and room and board to your credit card upon acceptance<br />
into a course.<br />
I’d like to contribute $___________ to the _______________________________________ Scholarship Fund.<br />
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