Woodmere Art Museum
Class Registration Form

______________________________________|___________|______________________
NameDateEmail Address

__________________________________________|________________|_____|_______
AddressCityStateZip

________________________|______________________|_________________________
Telephone (day)                 Telephone (evening)Emergency Contact = Telephone Number

__________________________________________|______________________________
Child's Age (If signing up for classes)Name of school child attends

Woodmere Membership
Woodmere membership is necessary for class registration. Annual Membership categories are:

Student ($20) (with a current student I.D.) Individual ($35)

Family ($60) Contributing ($100) Supporting ($250)

Patron ($500) Connoisseur ($1000) I am already a Woodmere member.

Classes
Yes, I would like to sign up for the following class(es):

A. Class Number _____                  Session  a     b     c
Instructor _____________________________________ Class Fee _________

B. Class Number _____                  Session  a     b     c
Instructor _____________________________________ Class Fee _________

C. Class Number _____                  Session  a     b     c
Instructor _____________________________________ Class Fee _________

Membership fee enclosed $________ Total amount enclosed $________

Please charge my  VISA  MasterCard  American Express

Card # ________________________________ Expiration Date ________

Signature ____________________________________________________

Make check payable to: WOODMERE ART MUSEUM
Mail to:

Education Department WOODMERE ART MUSEUM 9201 Germantown Avenue Philadelphia, PA 19118 215-247-0476