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March Break Visual Students
Greg Hindle, Gibson Centre, Artist in Residence
Dates: March 16 – 20, 2015 9:00 am – 4:00 pm daily
Location: Gibson Centre
Registration based on a first come first served basis
Name:
(Please Print) First
Email:
Last
City/Town:
Street Address:
Postal Code
Telephone (RES):
(BUS):
Grade:
Age:
Contact information will only be used to inform you of events sponsored by the South Simcoe Arts Council (SSAC).
Copyright: the submissions of any entry gives permission to SSAC to make and use images of accepted work for publicity,
documentary and archival purposes only including, the SSAC and GC website and publications.
With paid application, the applicant is indicating that they have read and they understand the rules for the Workshop and
give permission for photos to be released for media and SSAC purposes.
(If participant is under 18 years of age) I give permission for my son/daughter to take part in Workshop.
SIGNATURE OF PARENT/GUARDIAN:
Applicant Signature:
Must be signed or this Application will not be accepted.
DONATIONS are gratefully received in support of the SSAC/ GC
partnership.
Name and Address of Donor:
You may pay for the registration/donation by qcash, qcheque, or
CREDIT CARD: qVISA
qMasterCard
Name on Card (PLEASE PRINT)
__________________________________________
Signature_____________________________________
Card Number_________________________________ expiry _______
Make cheques payable to the South Simcoe Arts Council.
Materials FEE$200.00 week or $50.00 day
Donation
$______
TOTAL ENCLOSED
$______
DONORS- PLEASE COMPLETE THE
SECTION AT LEFT. A charitable receipt will
be issued for all donations of $20 and over. If
paying by credit card, complete the section
at left.
• DO NOT SEND CASH IN THE MAIL.
• DO NOT SEND CREDIT CARD
INFORMATION BY EMAIL.
Class Location:
Gibson Centre, 63 Tupper Street West, Alliston ON L9R 1E4
Class Dates:
March 16 – 20, 2015
$200.00 Full week
$50.00 Day
Please refer to the Brochure for daily outline.
PLEASE MAIL, DELIVER OR FAX THE COMPLETED FORM TO THE SOUTH SIMCOE ARTS COUNCIL:
Mailing address: Box 313, Alliston, Ontario, L9R 1V6.
Street Location: Alice’s Attic, Gibson Centre, 3rd Floor, 63 Tupper St. W., Alliston, ON L9R 1E4
Telephone:
(705)435-2378
Fax: (705) 435-7455 Email: [email protected]