Anderson Ranch Arts Center Workshop Catalogs 2010-2014 | Page 73

Please print clearly. Use one form per student.

2012 SUMMER WORKSHOP APPLICATION
This application must be completed by all students (adults and children) either from this catalog or online. Requests accepted on
first-come, first-served basis starting January 3, 2012.
STUDENT NAME _____________________________________________________________________________

MALE / FEMALE

MAILING ADDRESS _____________________________________________________________________________________________
CITY _____________________________________________________

STATE _________

ZIP CODE______________________

DAYTIME PHONE _______________________

EVENING PHONE ______________________

CELL _________________________

FAX _________________________________

E-MAIL ______________________________

BIRTH DATE____________________

IF THE STUDENT IS A CHILD PLEASE COMPLETE THE FOLLOWING: PARENT’S NAME _________________________________________
Please attach another sheet for additional workshop choices if you would like to enroll in more than five classes. Also indicate if you are
hoping to attend with friends or a family member. We will do our best but cannot guarantee your request.
1st Workshop
Workshop #

Workshop #

Instructor

Instructor

2nd Workshop

5th Workshop

Workshop #

Workshop #

Instructor

CANCELLATION POLICY: In order to cancel a work-

4th Workshop

Instructor

shop or housing reservation and receive a refund, you must
notify us at least 30 days before the start date of your workshop or housing reservation. If we are given the required 30
days’ notice, we will refund your deposits less the registration fee ($55/Adult – $30/Child), a workshop cancellation
fee ($100 per adult workshop; $30 per children’s workshop),
and a housing cancellation fee ($50 per week of housing
reserved). No refunds will be issued for cancellations made
within 30 days of the start date of the workshop or housing
reservation. If we cancel a workshop, you have the option of
transferring to another workshop, based on availability, or
we will refund your payments in full.

3rd Workshop
Workshop #
Instructor
1st Choice

2nd Choice

3rd Choice

Housing

_____ I have read and I understand the cancellation
policy. (Please initial)

Meal Plan

Deposits will be due upon acceptance into workshop(s) and housing to hold your space. The balance is due in full 60 days prior to the start
of your first workshop. We will automatically charge your balance to the credit card on file unless you have made other arrangements
prior to the due date.
Please check one:
(See page 2 for details)

o I wish to pay the Tuition Price.
o I wish to pay the Tuition + Studio Support Donation.

Deposit* ($300 per workshop) _________________
Housing Deposit ($100 per week reserved) _________________
Registration Fee ($55/Adult – $30/Child) _________________
Total Deposit Due _________________

*If the cost of the class
is less than $300,
then full payment is due
at the time of registration.

FOR HOUSING PURPOSES
Please describe physical limitations
(walking, stairs, etc.) and/or any
roommate or guest requests:

Payment method:

o Check, Money Order or Cashiers Check enclosed
o Visa, Mastercard, American Express, or Discover
Card Number:______________________________________ Exp.___________CVC___
Cardholder’s Name ________________________

Signature______________________

I wish to make a tax-deductible donation of $ ________ to support a workshop scholarship.
Mail this form with payment to Anderson Ranch Arts Center,
PO Box 5598 (USPS), 5263 Owl Creek Rd. (UPS, FedEx, etc.), Snowmass Village, CO 81615 – or fax this form to 970/923-3871