CIM Registration Form 2015

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Transcript of CIM Registration Form 2015

Registration form for Participation in Clay in Mind 2015

Northern Burlington County Regional High School. 160 Mansfield Road EastColumbus, NJ 08022

Directions: Please complete the following and mail it along with the $65.00 registration fee. Your registration form and $65.00 non-refundable check not purchase order, must be received no later than March 1, 2015. Please make check payable to Northern Burlington County Regional High School Clay In Mind. Also, please check out our website for more information and registration forms. http://clayinmindnj.blogspot.com/

Thank you for completing the following information fully and printing clearly:

Art Teachers Name: _____________________________________________________________________

*All communication will be by email. Thank you for including the following information completely and clearly.

*Your Email @ school: __________________________________________________________________

*Your Email @ home: ___________________________________________________________________

Name of High School: __________________________________________________________________

School Mailing Address: Street: ___________________________________________________________

City: ____________________________________________________ NJ Zip code: __________________

School County: ___________________________________

Principals Name: ______________________________________________________________________

Art Supervisors Name: _________________________________________________________________

Your Home Mailing Address: ______________________________________________________________

_____________________________________________________________________________________

Your Home County: __________________________________

Phone # @ school: _____________________________________________________________________

Your Home/Cell Phone: _________________________________________________________________

Mail the registration form and your $65.00 registration fee to:***PLEASE NOTE CHANGE FROM PREVIOUS YEARS*(We regret the need to increase the registration fee minimally. Please note the registration fee has not been increased since 2007).Northern Burlington County Regional High School160 Mansfield Road EastColumbus, NJ 08022

Attn: Julia KirchnerRe: Clay in [email protected]


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