Registration Form (please print and mail)
Each registrant must complete a registration form and provide all the information requested below.
Forms that are incomplete or that contain more than one name will not be honored.
Print this form and send it with your payment to:
Department of Teacher, School, and Family Programs
Teacher Workshops
National Gallery of Art
2000B South Club Drive
Landover, MD 20785
______________________________________________________________________
Name
______________________________________________________________________
Home address
______________________________________________________________________
City / State / Zip code
______________________________________________________________________
Home telephone / E-mail address
______________________________________________________________________
School name
______________________________________________________________________
School address
______________________________________________________________________
City / State / Zip code
______________________________________________________________________
School telephone / School fax
______________________________________________________________________
Subject taught / Grade level
______________________________________________________________________
Principal or supervisor
______________________________________________________________________
How did you hear about the National Gallery of Art's Teacher Workshops?
Check desired workshop(s). Repeat programs may be held if there is sufficient demand; please indicate whether you would also be available for the alternate workshop date.
Augustus Saint-Gaudens' Memorial to Robert Gould Shaw and the Massachusetts Fifty-fourth Regiment ($10)
[ ] Wednesday, January 20, 2010
[ ] (Repeat date: Wednesday, January 27, 2010)
Sol LeWitt: Art as Idea ($10)
[ ] Wednesday, March 3, 2010
[ ] (Repeat date: March 10, 2010)
Postwar Modernism: The Meyerhoff Collection ($10)
[ ] Wednesday, April 7, 2010
[ ] First-time participant (fee waived)
[ ] Past participant registering with a first-time participant (submit both registraition forms together) (fee waived)
Judith Leyster: A Leading Star ($20)
[ ] Saturday, November 7, 2009
[ ] (Repeat date: Saturday, November 14, 2009)
Alike, but Not–Alexander Calder and Brian Jungen ($20)
(Please check one workshop at each institution. Register for sequential Saturdays)
Balancing Act: Alexander Calder held at the National Gallery of Art
[ ] Saturday, February 6, 2010 (Session full - Wait list only)
[ ] (Repeat date: Saturday, February 20, 2010)
Strange Comfort: Brian Jungen held at the National Museum of the American Indian
[ ] Saturday, February 13, 2010 (Session full - Wait list only)
[ ] (Repeat date: Saturday, February 27, 2010)
Total amount enclosed: $__________