FLORIDA SOCIETY OF GOLDSMITHS -- REVERE ACADEMY EAST II
NAME: (Mr.) (Mrs.) (Ms)_________________________________________________________________________________
(CIRCLE ONE) (PLEASE PRINT)
ADDRESS:____________________________________________________________________________________________
CITY_____________________STATE____ZIP__________PHONE(s): Home ‑ ( )__________ WORK ‑ ( ) __________
EMAIL _______________________________ FSG MEMBER __________ N0N-MEMBER ___________
WORKSHOP PREFERENCE
You must sign up for 2 classes in this workshop -- 1 in each session. Please rank your preferences as 1, 2, 3, etc.
Every attempt will be made to schedule your first choice in each session.
| SESSION 1 | PREFERENCE | SESSION 2 | PREFERENCE |
| JEWELRY DESIGN -- Alan Revere | __________ | JEWELRY DESIGN -- Alan Revere | __________ |
| RENDERING - George McLean | __________ | RENDERING -- George McLean | __________ |
| FABRICATION I -- Christine Dhein | __________ | FABRICATION II -- Christine Dhein | __________ |
| SURFACES I -- Doug Zaruba | __________ | SURFACES II -- Doug Zaruba | __________ |
| STONE SETTING I -- Nancy Winthrup | __________ | STONE SETTING II -- Nancy Winthrup | __________ |
| GRANULATION I -- Ronda Coryell | __________ | GRANULATION II -- Ronda Coryell | __________ |
The workshop fee for a current Florida Society of Goldsmiths member is $900.00. The non-member fee is $950.00. The full amount is due with the application. This fee covers 2 class tuitions, lodging for 7 nights, 20 meals, and all gratuities. Those who find it necessary to cancel their reservation prior to September 1, 2001 will be charged a $50.00 service fee. Refunds for notice of cancellation received after that date will be charged a $75.00 service charge per person.
MAIL TO: FSG, 719 CENTRAL AVE., ST. PETERSBURG, FL. 33701
RELEASE
As part of the consideration in addition to the registration fee paid to the Florida Society of Goldsmiths for giving the course for which I have registered, I hereby release the Florida Society of Goldsmiths Board of Directors, its members, as well as any person or entity on whose property such course may be given, from any and all liability for personal injury or property damage that I may suffer or sustain due to negligence, or otherwise, in connection with any such course, whether by ingress or egress, attendance or otherwise.
ALL ATTENDEES MUST SIGN: Signature ____________________________________________________________________
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OFFICE USE ONLY
Postmark Date: ___________________
Total due for FSG members: $900.00 Total due non members: $950.00
Total Amount received with Application: $ __________________ Check # ____________________
All rooms are double occupancy with separate beds and private bath in each room. Please indicate with whom you wish to room or rely upon us to select for you.
I wish to room with: (Name) _____________________________________________________________________
(Address)_____________________________________________________________________________________
(Telephone)_______________ I wish to meet someone new. I am female _________ male________
Special consideration: (example: room with non‑smoker)___________________________________
DIETARY RESTRICTIONS
The Kitchen tries to accommodate dietary restrictions including vegetarians.________________________________
____________________________________________________________________________________________
TRANSPORTATION
We will try to help you with your transportation needs from Asheville. You will be provided with a list of commercial transportation available. Please be advised if you are flying into Asheville Airport, transportation will be available to Wildacres for an additional charge paid by you to the driver. Because there may be several arrivals, with only one trip planned, you may have to wait until all persons going to Wildacres arrive. It is imperative that we have this information as quickly as possible.
DATE OF ARRIVAL _________________________ DATE OF DEPARTURE _______________________
TIME OF ARRIVAL _________________________ TIME OF DEPARTURE ________ _______________
AIRLINE __________________________________ AIRLINE____________________________________
FLIGHT# __________________________________ FLIGHT# ___________________________________
For questions regarding transportation please contact:
719 CENTRAL AVE.
ST. PETERSBURG, FL. 33701
727/ 822-7872, EXT. 28
FSGrollins@aol.com
_____________________________________________________________________________________________________
IN CASE OF EMERGENCY
Please provide the following Information about whom we should notify in case of an emergency
NAME:_____________________________________________RELATIONSHIP___________________________
ADDRESS___________________________________CITY_________________________ST_____ZIP________
TELEPHONE( ) ___________Please list any medications that you are currently taking____________________
_____________________________________________Please list any medical conditions that would be important
for medical personnel to know in case of an emergency________________________________________________