2007 ArtSplot Registration Form


Parent/Gaurdian:________________________________________________
Name of Student:_________________________________________________
Address: ______________________________________________________
City:________________________________ State:_____ Zip:____________
E-mail: _____________________________________________________
Phone (home):______________________ (work):_____________________
Emergency Contact (name): _____________________ (phone):_____________
Programs (names & dates): _____________________________________
____________________________________________________________
Special Interests / needs / allegergies: _________________________________
____________________________________________________________
Would you like to donate a tax deductable contribution towards student scholarship funds?  
Amount of Contribution: ___________________________________________

ArtSplot T-Shirt $15.00 (Circle One)
Colors: Heather Grey / Natural  Sizes: Small Medium Large
ArtSplot Berets $15.00 (Circle One)
Colors: Black / Red  Sizes: One Size Fits All
Amt:______

Form of Payment: Check / Credit Card
Credit Card #: ______________________________________ exp: ________
**We are now accepting credit card payment**
**Payment on your credit card statement will be under ACES**

Mail to the ArtSplot:
Suite 212
111 S. Grand Ave.
Bozeman, MT 59715

All payments are non-refundable unless prior arrangements are made.

Notes:
Your e-mail address will help us to keep you current on ArtSplot/ACES offerings.