Register for Classes Form

* Required

Student Information
	* I have read and understand the registration policies as set forth on the last page of the Class Schedule, including all policies regarding fees.
* First Name:	Title:
Middle Name or Initial:
Nickname:
* Last Name:
Date of Birth:	[mm/dd/yyyy] (required for students under 18)
* Gender:
* Address:
* City:
* State:
* Zip:
Home Phone:
Work Phone:
Cell Phone:
* Primary Email:
Secondary Email:
* Are You An Arkansas Arts Center Member?	Yes No
* If Yes, under what name is your membership?
* If Yes, did you join in the past seven days?	Yes No
If you know your member number, enter it here:
If registering a child for Junior Arts Academy, choose t-shirt size:

Class Information
* Title of First Course:
* Class Code:
* Tuition:
Title of Second Course:
Class Code:
Tuition:
Title of Third Course:
Class Code:
Tuition:
Title of Fourth Course:
Class Code:
Tuition:
* Total:
Payment Policy: Payment in full is required at the time of registration. Please read registration and refund policies in class schedule before you register.

Payment Information
* Name on Card:
* Credit Card Type:
* Credit Card Number:	enter credit card number with no spaces or dashes, e.g. 123456789
* Expiration Date:
* Tomorrow’s Date:	Typing tomorrow’s date in the above boxes will help us distinguish between genuine contact information from individuals and that which is automatically entered by software programs.

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