Fred Oldfield Western Heritage Center Art Class Registration Form   Student Name (one per registration form): Age Group Select One Not in School Age 6-9 Age 9-15 Teens & Adults Name of Responsible Party for child student (Must provide if above student is under 18 ): Address: City: State: Zip: E-Mail: Emergency Telephone: I am already a Fred Oldfield Western Heritage Center Member    If you would like to purchase a membership with this order you can take advantage of Member Discounts immediately. Just select the membership catagory you desire from the dropdown box below.   Membership desired:    Please Select One from this list $10 - Art Class Membership $20 - Senior (62+) $20 - Student (full time) $30 - Individual $45 - Family (2ind + kids under 18) $100 - Associate (4 ind) $1000+ Heritage Patron (3yr Family Membership) $2500+ Heritage Proctor (9 year Family Membership) $5000+ Heritage Partner (LIfetime Family Membership) If purchasing a membership, please enter the price of membership selected WITHOUT the dollar sign (This price will be added to this order)    $   Please list the names of the classes you are registering for: 1. Please Select Class Desired from this list Tuesday 4:00 - 5:00pm Beginning Art - $6.00 per class per week Tuesday 5:30 - 7:00pm Intermediate Art: - $8.50 per class per week Wednesday 2:00-3:00pm Beginning Art- $6 per class per week Wednesday 2:00-3:30pm Intermediate Art - $8.50 per class per week Wednesday 4:00-5:00pm Beginning Art - $6 per class per week Wednesday 6:00-8:00pm Advanced Art - $10 per class per week Thursday 5:00 - 6:30pm Int. Art - $8.50 per class per week $   I have a sibling registered. Name: Additional child discount -10%          $ Grand Total for this Registration:          $     Credit Card Card you are using Visa MasterCard Card # Expiration Month and Year Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2007 2008 2009 2010 2011 2012 2013 2014 2015   Please send your check or credit card information (MasterCard or Visa) to: The FOWHC P.O. Box 1539 • Puyallup, WA 98371   Please fill out the form and submit once.

The Fred Oldfield Western Heritage & Art Center is a Non-Profit 501 (c) (3) Corporation
All donations to this Center are Tax Deductable.
Your generous contribution will be instrumental in bringing bigger and better arts opportunities to the citizens of our region.