FA L L 2 0 1 1 / W I N T E R 2 0 1 2 A P P L I C AT I O N PAY M E N T C H A R T F O R W I N T E R C O U R S E S : Course Length
Tuition
Room & Board
Additional charges for single room
Application fee (non-refundable)
(subject to availability)
One week
$750.00
$520.00 + sales tax
$320.00 + sales tax
= $561.60
= $345.60
$20.00
Please complete this application form and mail it to The Studio of The Corning Museum of Glass, One Museum Way, Corning, NY 14830-2253. Applications made by credit card may be faxed to 607.438.5150. There is no application fee for fall classes. Please include a $20 non-refundable application fee for one or two winter courses. Use a separate application form and enclose a $20 non-refundable application fee for each two additional winter courses. Name ________________________________________________________________________________________ Address ______________________________________________________________________________________ City _________________________________________ State ___________ ZIP Code ____________________ Country ____________________________ Email ___________________________________________________ Home # ________________________ Work # _______________________ Fax # _______________________ COURSE SELECTION First Choice (include session #) _________________________________________________________________
Fall
Winter
Date __________________ Instructor ______________________________________
Second Choice (include session #) ______________________________________________________________ Fall Winter Date __________________ Instructor ______________________________________ I would like to take both courses. If a course(s) is (are) filled, please place me on a waiting list.
W I N T E R P R O G R A M O N LY I would like housing. I am Male Female Age: ___________. I am attending with _______________________________________ and we wish to room together. I would like a single room ($320 + sales tax = $345.60 extra per week. Availability not guaranteed.) M E T H O D O F PAY M E N T Enclosed is a money order in the amount of $___________________. Enclosed is a check payable to The Corning Museum of Glass in the amount of $ ___________________. Please charge to: MasterCard
Visa
Discover
American Express
Name as it appears on card _____________________________________________________________________ Card number _____________________________________________ Expiration date ____________________ If you check this box, we will charge your tuition and room and board to your credit card upon acceptance into a course. I’d like to contribute $___________ to the _______________________________________ Scholarship Fund.
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