Event Registration

First Name: Last Name: Birth Date: / / Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip Code: - Zip Suffix Email: Phone: Number of Attendees: Photo Release YES - I give my permission for my child and artwork to be photographed at White Bear Center for the Arts and I agree that these images may be used for publicity and promotion purposes in printed materials, and on the website. No names or other identifying information will be attached to any photos. NO - I do not want my child's photo to be used, but I give permission for my child's artwork to be used for promotional purposes on the WBCA website, catalog, and other printed materials for publicity. Relation of Registrant to Attendees:   Same Household Same Company