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CLASS REGISTRATION
Before registering please read Registration, Cancellation, and Class Attendance Policies.
If you are in agreement, call 252 - 5222 with your Visa or MasterCard or print out this form, fill it out, and mail it with a check to The Living Arts and Science Center, 362 N. Martin Luther King Blvd., Lexington KY 40508. 
If you are registering by phone, please have the following information available.

1.  Currently an LASC member?  YES_____   NO_____
     I wish to become a New Member  $_____   Renew my Membership $_____  Click here for Membership Levels.

2.   Parent / Guardian Name______________________________________________________________________

      Home Phone______________  Work Phone______________  Cell Phone  _____________

3.   Mailing Address_____________________________________City_______________State_____Zip_________

4.   E-Mail ___________________________________________________________________________

5.   Student's Name____________________________________________________________________

6.   If student is under 18 yrs:  Age_____  Birth Date MM____DD____YY____  Male___  Female___

7.   Last school grade completed_____  School attended 2006_________________________________
      STUDENTS MUST HAVE COMPLETED THE GRADES INDICATED IN THE CLASS DESCRIPTIONS.
      (Home schoolers: Please go by the equivalent age (For example: K = 6 years old by October 1)

8.   Visa / MasterCard #________________________________________________Exp. Date__________

9.   Name as it appears on the credit card____________________________________________________

10.  Billing address for the credit card if different from home address_______________________________
 

	Session 1	Session 2	Session 3	Session 4	Session 5	Session 6	Session 7	Session 8	Session 9	Teens & Adults
AM Class # Fee
PM Class # Fee
Get Going Fee
Collaborate Elaborate Fee
Lunch Fee
TOTALS

Totals Combined_____________

Membership_________________

GRAND TOTAL______________