Registration form for Participation in

Clay in Mind 2015

Northern Burlington County Regional High School.
160 Mansfield Road East
Columbus, NJ 08022

Directions: Please complete the following and mail it along with the $65.00
registration fee. Your registration form and $65.00 non-refundable check not
purchase order, must be received no later than March 1, 2015. Please make
check payable to Northern Burlington County Regional High School Clay In
Mind. Also, please check out our website for more information and registration
forms. http://clayinmindnj.blogspot.com/
Thank you for completing the following information fully and printing clearly:
Art Teachers Name: _____________________________________________________________________
*All communication will be by email. Thank you for including the following information completely
and clearly.
*Your Email @ school: __________________________________________________________________
*Your Email @ home: ___________________________________________________________________
Name of High School: __________________________________________________________________
School Mailing Address: Street: ___________________________________________________________
City: ____________________________________________________ NJ Zip code: __________________
School County: ___________________________________
Principals Name: ______________________________________________________________________
Art Supervisors Name: _________________________________________________________________
Your Home Mailing Address: ______________________________________________________________
_____________________________________________________________________________________
Your Home County: __________________________________
Phone # @ school: _____________________________________________________________________
Your Home/Cell Phone: _________________________________________________________________

Mail the registration form and your $65.00 registration fee to:
***PLEASE NOTE CHANGE FROM PREVIOUS YEARS*(We regret the need to increase the
registration fee minimally. Please note the registration fee has not been increased since 2007).

Northern Burlington County Regional High School

160 Mansfield Road East
Columbus, NJ 08022
Attn: Julia Kirchner
Re: Clay in Mind
jkirchner@nburlington.com