YCAF Workshops Registration Form

Workshops begin January 5, 2004
I am signing my child up for:  (check one)
 

Creative Dramatics
Ages 7 – 11

Tuesdays, 4 weeks
3:30pm – 5:00pm

$75.00


 

Creative Dramatics
Ages 12 - 18

Wednesdays, 4 weeks
3:30pm – 5:00pm

$75.00

Intermediate
Ages 7 – 11

Mondays, 4 weeks
3:30pm – 5:00pm

$75.00

Intermediate
Ages 12 - 18

Thursdays, 4 weeks
3:30pm – 5:00pm

$75.00

Performance
Ages 7 - 18

Mon – Thurs, 6 weeks
5:30 – 7:00pm

$125.00

 Sibling discount rate:  Each additional sibling receives a 15% discount, and must provide a separate enrollment form.

________________________________________________________________
Students Name

________________________________________________________________
Address

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                                                                                                     Zip

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Home Phone

Method of Payment:  (circle one)            CHECK             VISA              MASTERCARD

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Credit Card #                                                                                         ________________
                                                                                                                 Exp. date

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Signature                                                                              

MAIL or FAX registration for to the address below.  Deadline for submission is December 20, 2003

Bellflower Theater Company
9831 Belmont St.
Bellflower, CA 90706		 Phone:  562 - 867 - 3524
Fax:  562 - 866 - 3667

Contact person:  Kathy Dietz