Monotype Marathon XII
Printable Registration Form

SPONSOR/PATRON
Name ____________________________________
Address __________________________________
City _____________________________________
State __________________Zip _______________
Day Phone _____________Eve Phone __________
Email address ______________________________

Name and phone# of artist you wish to sponsor:
_________________________________________

_________________________________________

__ Check here and the ICA will choose your artist

PAYMENT
Type of Payment (Please check one)
__ I enclose $250 (Sponsor level)
__ I enclose $500 (Patron level)

__ Check enclosed
(payable to SJICA - mail registration only)

Credit card (check one)
____ Visa ____ MasterCard ____ AmEx
Card Number
_________________________________________
Expiration Date _________________________________________

Signature ___________________________________

ARTIST
Name ______________________________________
Address ____________________________________
City ________________________________________
State ___________________Zip_________________
Day Phone ______________Eve Phone ___________
Email address ________________________________

Workshop Preference
I would prefer the following
workshop location and time:
Printing Location/Choice #1 ____________________
Date & Time/Choice #1 ________________________
Printing Location/Choice #2 ____________________
Date & Time/Choice #2 ________________________

Name and phone number of sponsor: ____________________________________________

or __ I am sponsoring myself (fill out payment at left)

Artists are strongly encouraged to find their own sponsors.
If you do not have a sponsor, we cannot guarantee your participation. If a sponsor becomes available, you will benotified well in advance of the workshop dates as to whether
or not you can participate.

Forms and payment due by May 17, 2004

Mail to:
MM XII, 451 S. First St., San Jose, CA 95113
Fax to: 408.283.8157 (credit cards only)
Phone: 408.283.8155 (credit cards only)