Make checks payable to: Susan vonMedicus/Icon Workshop
Send to: Post Office Box 455
Fort Washington, Pa. 19034
Email questions to: art@susanvonmedicus.com
** deposit will be refunded if the church or teacher needs to cancel the workshop
Please print out and mail form below with your check
Registration Form – 2012 Icon Painting Workshop – Extreme Humility
Church of the Good Shepherd
Name: _________________________________________________
Address: _______________________________________________
______________________________________________
Phone: ________________________ Email: ________________________
Deposit enclosed: ____________________