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
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.
Exploring Modern Art ($10)
[ ] Wednesday, January 16, 2008
[ ] (Repeat date: Wednesday, January 23, 2008)
Mathematical Patterns in Art ($10)
[ ] Wednesday, February 13, 2008
[ ] (Repeat date: Wednesday, February 20, 2008)
J. Carter Brown Memorial Evening with Educators: In the Forest of Fontainebleau: Painters and Photographers from Corot to Monet ($20)
[ ] Wednesday, April 9, 2008
Edward Hopper ($20)
[ ] Saturday, December 1, 2007
[ ] (Repeat date: Saturday, December 8, 2007)
Let the World In: Prints by Robert Rauschenberg at the National Gallery of Art ($20)
[ ] Saturday, March 8, 2008
[ ] (Repeat date: Saturday, March 15, 2008)
Total amount enclosed: $__________