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Spring & Summer brochure - Currier Museum of Art

Spring & Summer brochure - Currier Museum of Art

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Registration Form<br />

Become a <strong>Currier</strong> <strong>Museum</strong> <strong>of</strong> <strong>Art</strong> member and<br />

receive 10% <strong>of</strong>f classes at the <strong>Art</strong> Center!<br />

$30 Student (18+)*<br />

$45 Individual*<br />

$65 Dual Family**<br />

$100 Contributor**<br />

$175 Sponsor**<br />

$350 Patron**<br />

$1000 Benefactor**<br />

*Discount for card holder only<br />

**Discount extended to family<br />

Subtract 10% <strong>of</strong>f your class if you are<br />

a member, or signing up today.<br />

Please call 603.669.6144 x122 or x152 for info.<br />

Parent/Guardian’s Name<br />

Address<br />

City, State<br />

Zip Telephone Work/Cell<br />

Email<br />

Emergency Contact Name and Number<br />

Date<br />

Please list any special needs - allergies, ADHD, medical or behavioral issues <strong>of</strong> the<br />

student(s):<br />

<strong>Art</strong> Foundations / Weekly Classes<br />

Student(s)<br />

Age(s)<br />

Class(es) Session/Date Amount<br />

<strong>Art</strong> Camp for Kids! (Ages 5-12)<br />

Student/Session(s) Age Full Day Half Day Amount<br />

Student/Session(s) Age Full Day Half Day Amount<br />

Student/Session(s) Age Full Day Half Day Amount<br />

After Camp Care $25<br />

<strong>Art</strong>Ventures! for Pre-Teens (Ages 12-15)<br />

Amount<br />

Student(s)<br />

Age(s)<br />

Class(es) Session/Date Amount<br />

<strong>Art</strong> School for Teens & Adults<br />

Student(s)<br />

Age(s)<br />

Class(es) Session/Date Amount<br />

<strong>Art</strong> in the Evening for Teens & Adults (15+)<br />

Student(s)<br />

Age(s)<br />

Class(es) Session/Date Amount<br />

Workshops / Vacation Week<br />

Student(s)<br />

Age(s)<br />

Class(es) Date/Time Amount<br />

Method <strong>of</strong> payment: Cash (enclosed) Check (enclosed) Visa<br />

Subtotal<br />

MasterCard Discover American Express<br />

Discount<br />

Credit Card #<br />

Expiration Date<br />

Grand Total<br />

Security Code<br />

For tuition assistance information, please check.<br />

(3 - 4 digits on the back <strong>of</strong> your credit card)<br />

For Office Use Only<br />

Mail to: <strong>Currier</strong> <strong>Museum</strong> <strong>Art</strong> Center, 180 Pearl Street, Manchester, NH 03104<br />

Call: 603.669.6144 x122 or register online at www.currier.org.<br />

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