OVCAG Workshop Registration Form

To register for a workshop, complete the following form, print it, and mail it to:

Orchard Valley Ceramic Arts Guild
WORKSHOPS
10366 Avenida Lane
Cupertino, CA. 95014

There is no sign-up fee for this workshop (suggested donation $10). Persons under 16 may attend the workshop with approval of the workshop coordinator, and with parental supervision.

Registrations are not complete until the workshop chairman receives a signed copy of this registration form, and a check for the total amount of the workshop (including material fees, if any). Please allow adequate snail mail time!


Workshop Name: Recycled Glass Kiln Arts Workshop with Roger Kirby Date: November 21, 2004
First Name: Last:
Address:
City: State:      Zip:
Phone:
E-mail:
Are you an OVCAG member?     YES     NO

PARTICIPANT LIABILITY RELEASE:

I, the undersigned or parent/guardian of the individual named above do hereby agree to allow the named individual to participate in this activity, and I further agree to indemnify and hold harmless the Orchard Valley Ceramic Arts Guild and its members, officers and agents, the instructor(s) of this workshop, and the owner(s) of the premises, from and against any and all liability, save and except for their sole negligence, for injury associated with the named individual’s participation in this activity. I understand that participation in this activity may involve exposure to chemicals and materials known to be hazardous. I further agree to the use of the aforementioned individual’s photograph for program publicity.
Check the appropriate box:      Participant (18 or over)     Parent or Legal guardian

Signature: Date: