"Faux Enamel Reversible Pendant" Saturday
"Mixed Media Jewelry Construction" Sunday
Oct 1&2, 2005 with Julia Sober
Class Registration Form

Name________________________________________________________________________________________

Address_______________________________________________________________________________________

City__________________________________________________  State_______________ Zip_________________

Phone Daytime: ____________________________Phone Evenings:________________________________________

E-mail Address:_________________________________________________________________________________

Class fee: $75 per class.
Class hours 10am - 5pm Sat. and Sun.
Hall will be open from 9am to 7pm on Sat, and 9am until 6pm on Sunday.

Check classes you wish to attend:
____Faux Enamel Reversible Pendant
____Mixed Media Jewelry Construction

____SCPCG member. Please check if a SCPCG Member by Aug 1, 2005 for $5 discount per class
____NYPCG member. Please check if a New York PCGuild Member by Aug 1, 2005 for $5 discount per class
(only 1 local guild discount per person)
____National PCG member. Please check if a NPCG Member by Aug 1, 2005 for $5 discount per class

Total $_________________

Please make checks payable to: Southern Connecticut Polymer Clay Guild, Inc. (or SCPCG)
Send to Registration Coordinator: Sharon Mihalyak, 456 Jones Hill Rd., West Haven, CT 06516
Confirmations will be emailed to you,
OR, if you prefer, include a self-addressed, business sized envelope with 37 cents postage.

No refunds will be given after Sept 20, 2005.

Attendance at the SCPCG Class is contingent upon your agreement never to assert or make any claim for bodily injury, loss, or property damage suffered or incurred by you in attending or participating in such SCPCG Class activities.
All registrants MUST sign below indicating acceptance of all terms and conditions of the event.
Registrations cannot be processed without this signature.

The registrant also grants permission for publication any photographs and/or videos that may be taken during the event.

Waiver and Release Signature of Registrant_________________________________________________________
Date_____________________________