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 Pacific State 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 Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration 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. Sign up to receive news & events from VLANY!first_nameJohnlast_nameSmithemailjohnsmith@example.comSubmit
