CLICK! Registration Form

Friday March 30—April 1, 2012 in Pinedale, WY
(We recommend that you cut and paste this form on to a MS Word document and then print it out)

Name:

Address:

City, State, Zip:

Email:

Day/Cell Phone:

Registration fee (please check one):

___Early Bird Registration by March 15, 2012 -- $75     

___Late and Door Registration -- $100   

___Student Registration -- $50 (must have current student ID)

No refunds after March 23, 2012

Registration includes the opening reception, lunch and the Fellowship Awards Banquet

Payment options

___Cash 

___Check  Make checks payable to Wyoming Arts Council

___PayPal (available from WAC’s website at http://wyoarts.state.wy.us./Artists/Visual.aspx; accepts major credit cards. No account required.) Name on credit card used:                                         (PayPal users must still send in the registration form separately).

ADA accommodations available (Requests must be received by March 15, 2012):

___mobility/wheelchair 

___assisted listening

___large print 

___sign language

___other ____________________________

Portfolio Review

___I am applying for a Visual Arts Fellowship and would like a portfolio review

___I have NOT applied for a Visual Arts Fellowship and would like portfolio review (fellowship applicants receive priority).

Mail or fax completed form and payment to:

Wyoming Arts Council, 2320 Capitol Ave, Cheyenne WY 82002. Fax: (307) 777-5499