Class & Workshop Registration Form

Name:_________________________________________________Today’s Date___________________________


City:_____________________________ State:________________ ZIP:_______________

Phone:__________________________ Email:_____________________________________

This is for (circle one) Class or Workshop____________________________________(Title of Event)

Form of Payment:

Check#:___________ Enclosed check in the amount of $_______________

Credit Card: VISA MasterCard Total Amount of Charge$_______________

Name of Cardholder:_________________________________________________________

Credit Card #:____________________________________
Exp. Date:__________________

ZIP Code for billing on card:_________________________

Authorization Signature:_________________________________________Date:_________

Policies for workshop registration:

• Space is limited, reservations are required

• Payment in full is required at registration, to reserve your space (unless otherwise specified)

• You may request to be placed on a waiting list if the workshop is full.

• No cancellations within 30 days prior to workshop

• Cancellations prior to 30 days will be charged a 15% processing fee for cancellation.

• Lunch for workshops will be arranged based on majority preference. o Please circle your preference for lunch

o Order-in from a local restaurant. Pay for lunch at time of arrival

o Bring your own bag lunch

o Potluck – everyone bring a dish to pass (studio to provide tableware & beverages)

I look forward to hosting this experience for you at Khnemu Studio LLC – Dawn Soltysiak. Please contact me with any questions, or to check workshop availability.

Registration Form

6322  113th Ave
Fennville, MI

​Phone: (269)686-6343 

...a connection to the artist and the land