Your name:

First: Last:


Address:

Street:

City: State: Zip:

Phone:

E-mail:



Status: (select one) Student Professional Professor/Instructor Other


If you are currently a student please list your school:


Specific area of study/major:


If you are a professional or instructor please list your company/institution:

Registration Fee you are Paying:



$40   students w/valid I.D.

$95   non-students

 

I will be paying the registration fee by:
(all fees must be received before your spot and registration is confirmed)

In person
Bring cash, check, or money order to the check-in desk at the lecture. Day-of lecture payments will be accepted only while seating is available.


PayPal
(link to paypal will be provided on the page that follows submission of this form.
A $5 processing/handling fee will be added for all PayPal transactions).

Double check the information you entered above.
Clicking SUBMIT indicates that you are reserving one seat for the lecture you have chosen. Admission will not be allowed until your payment is received in full.

E-mail lectures@manifestgallery.org with any questions.

(A copy of your registration will be automatically sent to the e-mail address you provided.
Please print and retain the e-mail and bring it to the lecture for admittance.)