Registration Form for Canadian Clay Symposium 2010 - bar code #201826
Name:
Address:
City or Town:
Province:
Country:
Postal Code:
Phone:
Email:
Payment:  
cheque (payable to City of      Burnaby)
visa
mastercard
american express

No. of registrations
Credit Card #
Expiry Date
Total Amt.
Signature
Date
Notes:
  1. This is a printable form only. It is not interactive.
  2. Mail this form with cheque or Credit Card information to:
    Canadian Clay Symposium Registration
    c/o The Shadbolt Centre for the Arts
    6450 Deer Lake Avenue
    Burnaby BC, V5G 2J3
    Canada
  3. To support the Clay Symposium's Green Initiative we will send as much information as possible by email or present it to you as part of our internet presence in the form of a Green Initiative Post-Registration Page on our website.