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Summer 2008 Registration & Membership Form (please print)
Summer Session 1 Registration Deadline June 05!
Register before Deadline and Save $5 off Tuition/ $5 Late Fee for Registrations after Deadline

Student Name:___________________________________________________________________

Name of Parent (If student Under 18)_______________________________________________________

Address: __________________________________________________________________________

City:_______________________________________ State:__________ Zip:___________________

Home Phone: _______________________ Work/Cell Phone: __________________________

Email: _________________________________________________________________

Class #	Tuition	Discount	Total
	$		$
	$		$
	$		$
	$		$
Membership : Are you currently a member of CCA? Yes__ No__ If you would like to become a member, please choose from the following levels:		Membership:	$
		Grand Total:	$

___ $45 Individual	___ $70 Family	___ $100 Supporter
___ $ 250 Patron	___ $500 Sponsor	___ $1000 Benefactor

Payment Method:_
[_] Cash [_] Check#_________ [_] Visa__[_]MC

Card #: __ __ __ __ ---__ __ __ __---__ __ __ __---__ __ __ __ Expiration Date:____ __ / __ __

Payment Date:___________ Payment Amount:$__________

Signature: _________________________________________________
(I understand all Art Center policies including the refund and publicity policies.)

RETURN COMPLETED REGISTRATION FORM WITH PAYMENT:
Cheltenham Center for the Arts, 439 Ashbourne Rd., Cheltenham, PA 19012