Requested Workshop:

Agency:

Tax ID number:
(If Tax Exempt)

Program Director:

Street Address:

City:

State:

Zip Code:

Phone:

Number of People:
(min. 6, max. 12)

Location:

Dates Requested:

Workshop Desired:

Cost:

Payment Method:

Comments:

Please make check payable to Rochesterclayworks.
Send check to: Rochester Clayworks, 203 Milburn Street, Rochester, NY 14607.

Questions? Please call 585-244-1098, or email us at mbf@rochesterclayworks.com