Class and Workshop Registration Form

Please complete the registration form below and mail it together with your check to:

Lake Elmo Regional Art Center, 3585 Laverne Ave. N. , Lake Elmo , MN 55042

For additional information or supply list call 651-256-1407.

Student Name: __________________________________________________________________

Parent’s Name (if under 18): _______________________________________________________

Email (optional): ________________________________________________________________

Address: _______________________________________________________________________
City : _________________________________ State: ______ Zip Code: ____________

Phone Number: ___________________ Cell Phone Number: ____________________

Class Name: _______________________________________

Class Start Date: _______________________________________

Class Time: _______________________________________ Class fee: $ _________

I would like to become a member! (Circle One) Membership amount $ _________

LERAC Membership Levels: Individual - $35, Family - $50,

Contributor - $50-$99, Sustaining - $100-$499, Benefactor - $500 - $999

and Patron - $1000 and up

Total Enclosed: $ _________

Check Number: __________ or Cash $ _________