Teachers' Weekend

Registration



First Name:
Last Name:
Address:
City, State:
Zip:
Email:
Phone:
This registration is for (check one):
Teachers' Weekend
August 25 and 26
Saturday and Sunday
$100.00
Teachers' Weekend
August 25
Saturday Only
$75.00
Teachers' Weekend
August 26
Sunday Only
$50.00

Payment Information
PLEASE CHARGE MY ORDER TO MY:       VISA     MASTER CARD   DISCOVER
Enter total enrollment fee to be charged to your credit card:
Card Number: Expiration Date: CID#:
CID# is the three digit number located on the back of your credit card.
Name as it appears on the credit card:
Address associated with the billing address on the credit card:

Should you wish to pay by check, fill out then print this form and mail it with a check to:
PCPA
Attn: Casting Director Erik Stein
800 S. College Drive,
Santa Maria, CA 93456-6399



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