Sign Up: Registration Form

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Name *

Email *

Which class are you signing up for?

The Art of: Mushrooms ($100 fee per person; Includes meal cooked during class & meal taken home that includes duck confit & broccolini)

The Art of: Cheesecakes ($30 fee per person; Includes slice of cheesecake)

Phone Number *

Birthday *

YYYY

Emergency Contact. Please state name and 2 phone numbers *

I hereby consent to be interviewed, recorded, photographed, videotaped or filmed by representatives of Pneuma Wind of Hope, Starfish Cafe, and MKD Education Center for purposes of publication, display or broadcast (print, web, digital display and all other forms of media).

I agree that such interviews, recordings, articles, quotes, photographs, films, audio or video and/or any reproductions of same in any form, are the property of the Pneuma Wind of Hope, Starfish Cafe, and MKD Education Center, and I relinquish any present or future claim for reimbursement for said photographic or film reproduction of my likeness or for said testimonials by me.

I hereby release the Pneuma Wind of Hope, Starfish Cafe, and MKD Education Center, its affiliates, employees, representatives and agents from any and all claims, demands, costs and liability that may arise from the use of these interviews, recordings, photographs, videotapes or films, and/or any reproductions of same in any form, as described above, arising out of being interviewed, recorded, photographed, videotaped or filmed.

I acknowledge that I have read this consent form in its entirety, or it has been read (or translated) to me, and I have had the opportunity to ask questions about it and understand it
*

Yes

If you are paying online please visit: https://www.paypal.com/paypalme/pneumawindsofhope?locale.x=en_US

There is also a link to pay the registration fee through our website under the Mary Kay Deen Education Center Tab.

If you are submitting payment through pay pal you must include the following:

Full Name

Which Class you are registering for

Other payment options include payment with card in person using square Point of Sale or cash brought to the classes.

The Art of Mushrooms

Nov 2

Thursday 6 pm - 9 pm

($100 one-time registration fee)

The Art of Cheesecake

Dec 1

Wednesday 6 pm - 8 pm

Please sign your name below to indicate you accept the terms of payment:

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