Print this form, complete it, and send it with your check or credit card information to:

Charles H. MacNider Art Museum
303 Second St SE
Mason City, IA 50401
Phone: 641-421-3666

Name _____________________________________________________

Name of Participant (if different from above)

________________________________________________________

Age of Participant (if registering for children's classes)____________________

Address ____________________________________________________

City ____________________________ State ________ Zip ___________

Phone ______________________ Email __________________________

CLASS _________________________Time ___________Fee $________

CLASS _________________________Time ___________Fee $________

CLASS _________________________Time ___________Fee $________

TOTAL enclosed $ __________

(Check payable to MacNider Art Museum)

Mastercard/Visa/Discover (please circle)

Account # _______________________

Exp. Date _______________________

Signature ______________________________________________

Registration and Class Information.

Return to the MacNider Web site.