Event Registration Form Demo Name* First Last Company / Firm NameAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificState ZIP Code Daytime Phone*Email* Membership DiscountAre you a VLA Member trying to register for this class? E-mail or call VLA to get your membership discount code and enter it here! - registrations@vlany.org or 212.319.2787 x 10 Select Ticket / Membership Status*Full-Time Student - $20Artists Over Sixty - $20Arts Professional - $40Legal Professional - $70Young Associate Members (YAM’s) and Associate Board Members - $50Student IDStudents must present proof of full-time status with registration -- please upload a snapshot here.Accepted file types: jpg, png, gif, jpeg, pdf.QuantityPlease indicate if you would like to register multiple attendees.Please enter a number from 1 to 12.Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112Year20202021202220232024202520262027202820292030203120322033203420352036203720382039Expiration Date Security Code Cardholder Name Please click "Register" just once to process your secure online transaction. You will receive a confirmation message when it is complete.CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. Sign up to receive news & events from VLANY!johnsmith@example.comJohnSmithSubmitForm is being submitted, please wait a bit.
