REGISTRATION-

ADULTS------------------- $175.00

TEENS--------------------- $125.00

CHILDREN UNDER 11YRS.---$ 75.00

ROOM AND BOARD-----------$160.00

POLO SHIRTS WITH LOGO----------$15.00

SIZES SM.____MED.___LG.___X-LRG____XXLRG___.

TO HAVE ONE READY FOR YOU, YOU MUST ORDER WITH YOUR REGISTRATION BY JUNE 30, 2003

MAKE CHECKS TO S.M.I.L.E. PLEASE DO NOT SEND OR BRING CASH FOR REGISTRATION OR ROOM & BOARD

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Registration Form
Please Complete This Form Using A Separate Form For Each Person.

Name__________________________________________________

Address________________________________________________

City, State ______________________________________________

Zip Code _______________________________________________

Phone _________________________________________________

E-mail _________________________________________________

Registration Fee _______________

Room & Board _________________

Subtotal _______________

Deposit _______________

Balance Due ____________

1st Timer Adult Teen Child

Special Needs:

 

Preferred Roommate:____________________________________

Please select the art forms that you will probably spend most of your class time in, giving 1st and 2nd priorities:

Clown___ Mime___ Puppetry___ Dance___ Storytelling___ Juggling___

 
Please Make Checks Made Out to: S.M.I.L.E.

Enclose Your Deposit and Mail To:

S.M.I.L.E.

C/O BEV STIVES

31700 ELECTRIC BLVD

AVON LAKE OH 44012

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