Order This Basic Photography Course
By Kitty A Stellby - ©2001-2004

Parent's Name _________________________________________________

Street Address _________________________________________________

City/Town _____________________________________________________

State/Province _________________________________________________

Country _________________________________

Zip Code _________________     Phone # __________________________

E-Mail Address _________________________________________________

Type of Camera:  Film Camera ____ Digital Camera ____

FOR SINGLE STUDENT USE:

Student's Name ________________________________________________

Student is:  Male ____ Female ____     Date of Birth: _________________

Year in School: ____    Do you need a written grade?  Yes ____ No ____

FOR CO-OP or GROUP USE:

Name of Co-Op or Group _______________________________________

Number of Students/Members ____ Written grades?  Yes ____ No ____

Comments: ___________________________________________________ ______________________________________________________________

How did you find out about me/this site?
Friends/Family _____    Search Engine Result _____
Link on a Home School Site _____    Link on a Charter School Site _____
Link on Another Site _____    Home School Recommendation _____    
Charter School Recommendation _____    Just Surfing _____

Parent's Signature ___________________________    Date ____________