Instructions:

If you have not already done so, please read the General Information page before proceeding.

Registration is on a first-come, first serve basis. You may use this form to electronically submit your registration request. You must then MAIL a check, in the amount of the required tuition deposit, $150.00, in order to secure your placement in the class. Your deposit check MUST be received within 7 business days of submitting this electronic form or your registration will not be considered valid and you risk loosing your class placement.

Make your check payable to "Long Island Photo Workshop"

Note your name, telephone number and class on the check

Mail it with a copy of this completed registration form to:
2174 Mitchell Street, Bellmore, NY 11710

Registration Info:

Your Name:

Email address:

Studio Name:

Address:

City, State, Zip:

Telephone number:

Your T-Shirt Size:

Small Medium Large Extra Large Extra, Extra Large Please Select Size

Are you a member of PPGNY/PPSNY?

 Yes     No

Are you a PPA Member:

 Yes     No
If yes, please give your PPA number:

NOTE: PPA number must accompany application or your will not receive your PPA merits!

Have you attended any workshops before?

 Yes     No

Comments:

Tuition Schedule:

Instructor Members* Non-Members Kevin Kubota One Week Digital Intensive $550.00 $600.00 Eddie Tapp, MEI, M. Photog., Cr., CPP Professional Digital Imaging $550.00 $600.00 Monte Zucker, M. Photog., Cr., F-ASP A Week With the Legend! CLASS FILLED - SORRY! $550.00 $600.00 Joseph & Louise Simone, MPA-CPA Artistic Portraiture $550.00 $600.00 Gary Small, M. Photog., Cr., CPP, CEI Photoshop: Taking it to the Next Level $550.00 $600.00 *Membership in Professional Photographers of Greater New York (PPGNY), Professional Photographers' Society of New York (PPSNY) or Professional Photographers of America (PPA) $50.00 Discount If tuition is paid-in-full prior to July 1, 2003!

Course Selection:

Select FIRST choice:

Eddie Tapp Kevin Kubota Joseph & Louise Simone Gary Small 1st Choice Selection

Select SECOND choice:

Eddie Tapp Kevin Kubota Joseph & Louise Simone Gary Small 2nd Choice Selection

Form Submission:

Please be sure to check all of the above information carefully, especially your email address, before submitting. Thank you.