Registration Form
for
Photo Workshops and Tours
Taught by
Charles Bush

Please make check/money order payable to Charles Bush. Credit Cards also accepted.
Date of Workshop _____________________________

Amount Enclosed $________________
Cost: $499.00, including supplies. For Digital SLR, Large Format Printing and Websites for Photographers
$899.00 for Photo Tours
Credit Cards are accepted (see below if you would like to charge this to your Visa, Master Card or American Express).
$150.00 nonrefundable deposit holds space, Balance Due 60 days prior to workshop. Payments only refundable if I can fill space.
Name ____________________________________

Address __________________________________

City _____________________________________

State __________ Zip Code ________________

Home Telephone ____________________

Business Telephone _________________

Fax ______________________________

E-Mail ____________________________

Credit cards accepted are:

Visa ____ Master Card ____ American Express ____

No. __________________________________

Expiration Date ______________________ CVV Number:

____________________________________________
(Name as it appears on the credit card)
In making this application I accept the terms and conditions and set forth above.

Date: __________________

How did you learn about these workshops?

Please Return To:
Charles Bush
12 Cobblestone West
Houma, LA 70360

Refund policy: if participant cancels fee is non-refundable unless workshop is full and there is a waiting list with a replacement to fill registrant's space. If workshop is canceled fee is fully refundable. However, Charles Bush is not responsible for any other costs incurred in connection with the workshop.