BCA Class Registration/Membership Form

Belton Center for the Arts
Class Registration/Membership Form

Print this form after completing. Mail or hand deliver with fee to the address at the bottom of the page.

Type information in the text boxes: (Results typed is not saved or transmitted.)

Name

Age (if under 18) Parent's/Guardain Name (if under 18)

Address City State Zip

Phone: Day Evening Email

Emergency Contact Name Phone

Scholarships available ... just ask. We don't want anyone to miss the fun!	Class 1 / Camp / Session	Fee
	Class 2 / Camp / Session	Fee
	Class 3 / Camp / Session	Fee

Membership (Click One): Member Non member

Membership Application (Check Box): Yes! Sign me up today (See below)

Membership Dues are tax-deductible to the extent provided by law.

Membership Fee

Total

Mail or hand deliver with fee to:

Belton Center for the Arts
PO Box 368 / 306 City Square
Belton, SC 29627
864 338-8556
864 338-0280 fax

My Check is enclosed: Check #:
(Payable to the Belton Center for the Arts)
Please charge my credit card
Visa Mastercard
Card Number
Expiration Date

Signature ___________________________________