Please PRINT this form, complete all parts, sign it and mail it to (or fax with credit card information to 301-565-3809):
Arts and Humanities Council of Montgomery County (AHCMC)
801 Ellsworth Drive
Silver Spring, MD 20910
The seminar will start promptly at 10:30 AM. The March 26, 2006 seminar will be held at the Round House Theatre Education Center located at 925 Wayne Avenue, Silver Spring, MD.
* Check enclosed payable to AHCMC
* Credit Card(complete information below)
Name on card:________________________________________________
Billing address (if different from above):_____________________________
City, State and Zip:____________________________________________
Phone number of cardholder (if different from above):_________________
Type of card: [ ] Visa . [ ] MasterCard . Exp. Date:__________________
By my signature I agree to the terms and conditions as stated in the prospectus form for this seminar.