Art Studio - Request to Register Please be aware that completing this form does not ensure you are registered yet. You will be registered in the event that the class or workshop is not full, and that your form is received before the due date. Either way we'll be in touch with more information!Which class/workshop are you requesting registration for?*Alcohol Inks on Glass - July 3rd 2021, 2:30-4:30pmAlcohol Inks on Ceramics - July 17th 2021, 2:30-4:30pmPain in the Arts - September to October 2021Your Name* First Last Your Email* Your Phone Number*ParticipantsLet us know who's all coming to the class/workshop!Who are you registering?*Myself onlyMyself and othersOthers, but not myselfHow many other people are you registering and paying for?*(If you are registering 4+ other people, please call our reception at 604-283-7827 ext. 0 and we'll help you register over the phone.)One personTwo peopleThree peopleParticipant #1 Name* First Last Participant #1 Email*If this participant is a child, please provide their parent's or guardian's email. Participant #1 Phone*If this participant is a child, please provide their parent's or guardian's phone.Participant #2 Name* First Last Participant #2 Email*If this participant is a child, please provide their parent's or guardian's email. Participant #2 Phone*If this participant is a child, please provide their parent's or guardian's phone.Participant #3 Name* First Last Participant #3 Email*If this participant is a child, please provide their parent's or guardian's email. Participant #3 Phone*If this participant is a child, please provide their parent's or guardian's phone.PaymentOnline registration for classes and workshops must be paid for by credit card. Please refer to the corresponding workshop or class webpage to find the cost. If you would like to pay using an alternate payment method, please contact our reception at 604-284-7827 ext. 0.Cardholder Name* First Last Account Type*VISAMastercardAmerican ExpressAccount Number*Expiration Date*Please enter "01" for the expiration day. Thanks! YYYY MM DD3 Digit Security Code*You can typically find this number on the back of your credit card.Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Consent* I understand that my credit card will be charged for all participants included in this form.Consent* I understand that classes are offered as a whole, and refunds will not be available for missed sessions.Consent* I authorize the above named business to charge the credit card indicated in this authorization form, on the date of each session or due date for a retainer agreement, according to the terms outlined above, and according to the Alongside You cancellation policy. I authorize Alongside You to charge my account for services rendered, including retainer payments. This is permission for recurring transactions related to clinical services, and does not provide authorization for any additional unrelated charges or credits to the account. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.Cardholder Signature*CAPTCHAWhat to Bring:Please wear clothes that can get messy!During COVID-19 we also require masks in our building common areas.
