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| Muncy Historical Society's Workshop Registration Form Friday, July 18, 6 – 9 p.m.
This 4th Annual Quilt Show is supported by the PA Council of the Arts, a state agency, through its regional arts funding partnership, PA Partners in the Arts (PPA). State government funding comes through an annual appropriation by PA’s General Assembly and from the National Endowment for the Arts, a federal agency. INSTRUCTIONS: Please type or write in black ink. Use only one form per person; you may copy this form for a friend(s). Make a copy of the completed form for your records. Mail completed form with your payment to: Muncy Historical Society, PO Box 11, Muncy, PA 17756. Appraisal schedule and workshop/lecture registration(s) will be confirmed prior to show.
Last Name_______________________________ First _______________________ Initial _____________
Address ________________________________ City ________________ State
_______ Zip___________ Telephone (Include area code) _____________________________________________________________
E-Mail Address ________________________________________________________________________ Referred by ___________________________________________________________________________
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