fa l l 2 0 0 9 / w i n T e r 2 0 1 0 a P P l i C aT i o n PAy M E N T c h A R T F O R W I N T E R c O u R S E S : Course length Tuition room & Board additional charges application fee for single room (non-refundable) (subject to availability) one week $750.00 $520.00 $320.00 $20.00 Please complete this application form and mail it to The Studio of The Corning Museum of Glass, One Museum Way, Corning, NY 14830-2253. Applications made by credit card may be faxed to 607.974.6370. There is no application fee for fall classes. Please include a $20 non-refundable application fee for one or two winter courses. Use a separate application form and enclose a $20 non-refundable application fee for each two additional winter courses. Name ________________________________________________________________________________________ Address ______________________________________________________________________________________ City _________________________________________ State ___________ ZIP Code ____________________ Country ____________________________ E-mail __________________________________________________ Home # ________________________ Work # _______________________ Fax # _______________________ cOuRSE SELEcTION first Choice (include session #) _________________________________________________________________ Fall Winter Date __________________ Instructor ______________________________________ Second Choice (include session #) ______________________________________________________________ Fall Winter Date __________________ Instructor ______________________________________ I would like to take both courses. If a course is (courses are) filled, I would like to be placed on a waiting list. W I N T E R P R O G R A M O N Ly I would like housing. I am Male Female Age: ___________. I am attending with _______________________________________ and we wish to room together. I would like a single room. ($320 extra per week. availability not guaranteed.) M E T h O d O F PAy M E N T Enclosed is a money order in the amount of $___________________. Enclosed is a check payable to The Corning Museum of Glass in the amount of $ ___________________. Please charge to: MasterCard Visa Discover American Express Name as it appears on card _____________________________________________________________________ Card number _____________________________________________ Expiration date ____________________ Please charge my tuition and room and board to my credit card upon acceptance into a course. I’d like to contribute $___________ to the _______________________________________ Scholarship Fund.