Xiem Clay Center Online Registration

Registration

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Sorry, but the class: "Advanced Intermediate Hand Building (TEW1)" is no longer available.

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Referral Information

How did you hear about us?

Referral Name

Credit Card Holder Information

Group (if applicable) Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

First Name*

Last Name *

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Payment Information

Class fees are due upon acceptance of your web registration and will be charged against the credit card number provided. If you are eligible for any special discounts such as being a continuing student in the immediately preceeding class term or, if you are a dues-paying studio member, then please note this information in the comment field below.

I've read the above and agree.

Signature Text

Xiem Clay Center reserves the right to cancel, combine, or reschedule classes in order to adjust for enrollment. The minimum number of students needed to confirm a class is 3 and the maximum enrollment is 10. If Xiem cancels a class or changes the scheduled time, students will be offered an opportunity to transfer to another class. If a student does not wish to transfer, then a full return will be given. Tuition is fully refundable up to three weeks before a class. If a student cancels registration there is a cancellation fee of $25.00 if less more than one week but less than three weeks notice is provided. If registration is cancelled within one week of the class start, the cancellation fee is $100.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*