Class Registration Register below for our 2023 Fall Workshop. For more information regarding this workshop CLICK HERE Minerva Fall 2023 Registration Please register for our fall workshop, "Ivy+Bean, The Musical" below. Please fill out one form for each student if registering multiple students. For any questions, or to inquire about a scholarship, please contact Cassi @ info@minervaartscenter.org. Student InformationStudent Name* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Please enter a value between 0 and 99.Name of Parent or Guardian* First Last Email* Phone*Secondary Email (optional) Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency InformationEmergency Contact Name* First Last Emergency Contact Phone #*Alternate Emergency Contact Name AND NumberAllergies or Other Medical Conditions?*YesNoDetails*Do you wish to provide more information that may be helpful in an Emergency*YesNoStudent's Primary PhysicianPreferred Hospital for Emergency treatment if necessary?SchedulingKnown or Possible Schedule Conflicts2023 Fall Workshop "Ivy+Bean, The Musical"* Price: $325.00 Check OutTotal $0.00 I want to pay workshop tuition...*... now with PayPal... later with a check (Checks payable to Minerva Arts Center.)...pay by invoice or payment planEmailThis field is for validation purposes and should be left unchanged.
