Scott Robert Next Level Registration
Thank you for your interest in attending a Next Level workshop. To register please fill out the information below.
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First Name
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Last Name
Company
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Address 1
Address 2
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City
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State
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Postal Code
Country
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Business Phone
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Email Address
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Workshop(s) I would like to register for
Payment Options
Terms: A minimum retainer fee of $800 is required to reserve your spot per workshop. This fee is not refundable but if there is another student willing to take your place, a refund will be issued minus a 10% processing fee or minimum of $80. Balance is due one month before workshop. I accept Visa or Mastercard (call 626 487-4166, skype: scottrobert) Paypal and checks. Please send Paypal payments to
scott@scottrobertgallery.com
or contact me to send check.
Please indicate how you would like to pay and if you would like me to contact you for payment. Or submit SECURE payment below.
Visa or Mastercard payment online
Name on Card
Billing Address if different from above
Zip
Credit Card Type
Visa
MasterCard
Credit Card Number
CSC Code
Expiration Date (mm/yy)
Amount
Payment via Paypal
Please send
Paypal
payment to
scott@scottrobertgallery.com
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