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www.aifl.edu/photographyexhibit

Registration Information (Please complete the following)

Last Name

MI

First Name

State

Zip Code

Physical Address City Mailing Address

/

City

State

Zip Code

Home Phone Number

eMail Address

Cell Phone Number

Company Name

Title

Office Phone Number

Billing information q

Visa

Name as it appears on card

q

Mastercard

q

AmEx

q

Discover

Card Number

Billing Address City

/

Date of Birth (MM- DD- YYYY)

(If not same as Physical Address)

State

Zip Code

Cardholders Phone Number

eMail Address

Exhibition & Lecture Events Student Rates (Must be able to provide Valid ID)

Non- Student Rates

q

Exhibition Only

$ 15.00

q

Exhibition Only

$ 25.00

q

Exhibition + One Lecture

$ 35.00

q

Exhibition + One Lecture

$ 75.00

q

Exhibition + Two Lectures

$ 50.00

q

Exhibition + Two Lectures

$ 100.00

q

Exhibition + ALL Lectures

$ 195.00

q

Exhibition + ALL Lectures

$ 550.00

Ai Form Final.indd 1

4/29/10 4:06 AM


ai file  

homework from school I need to turn in

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