Playshop
Registration Form 2009
Registration is limited to 10 participants. There is a waiting list when playshop is filled.
Please complete this form and send to:
Rob Kennedy
6-1855 Maple Ridge Dr,
Mississauga, On
L4W 2N7
Name_____________________________________________________________________
Address___________________________________________________________________
Postal Code________________________ Ph: _____________________________________
E-mail
____________________________________________________________________
[ ] 1-Day
Lens Painting
(Emotion in Motion)
Sept 13th /
Oct 25th
$85.00
[ ]
1-Day Shot
in the Dark
(Night Photography)
Oct 31st
$85.00
[ ] 1 -Day
Sky’s the Limit
Nov 7th
$85.00
[ ] 1 -Day
Extreme close-up
Nov
14th
$85.00
(Food & Lodging not included)
Please check one:
[ ]
I have enclosed $85.00 as payment in full for the 1-day playshop.
[ ]
I have enclosed $250.00 as payment in
full for all 4 playshops.(over 25%
discount)
[ ] I have enclosed payment of $165.00 as I’ve already enrolled in the Lens painting
playshop,
entitling me to all 4 playshops at over
a 25% discount in 2009.
Waiver of Liability
I agree that during this playshop, Rob Kennedy and his agents shall not be liable or responsible
for any claims or damage arising from personal injury to any participant or other person or for any damage, loss or theft of personal property of any participant or other person, however caused.
Rob Kennedy reserves the right to alter the time, context or format of the playshop to suit the needs
of the participants should circumstances require.
Signed ____________________________________________________
Date ___________________________________________________