Name *

First Name

Last Name

Phone *

(###)

###

####

Would you like for your class registration to cut off one week before the class starts? *

*For instructors to be paid sooner, we have cut registration for classes one week before the class starts. If the time of receiving your payment is not an issue, you have the option to continue your registration past the one-week cut-off.

Yes, cut registration for my classes a week before they take place.

No

If you selected NO for the above registration cut off:

Name of Program *

Brief Description of program: *

Is the program a repeating class for repeating participants? *

*i.e., a 6-week class that meets once a week with the same participants each week?*

Yes

No

If you answered YES to the above, how long does the program run?

If you answered YES to the above, how often does the class meet?

Duration of each class * 30 minutes 1 hr 1 hr 30 min. 2 hrs 2 hrs +

Number of classes willing to teach

min. participants per class *

max. participants per class *

*if the class occupancy is more than 30 people, insurance will be required*

Age group[s]:

Type of room needed: * Classroom Theater Kitchen Outdoor space Art room Media room

If you are needing more than one room for your program, please explain why here:

Are there any special needs/requirements for your program? *

Yes

No

List special needs/requirements here:

Table & Chair Accommodation

*the instructor is responsible for table and chair set-up*

Amount of tables

Amount of chairs

Proposed cost per participant

$

Are materials included in participant fee? *

Yes

No

If material fee is not included in participant fee, what is your material fee?

$

If the Mary C. became interested in utilizing your services, would you be interested in the opportunity?

Yes, I would love the opportunity.

No thank you.

Not applicable

If you answered YES to the above, what is your hourly rate?

$

* standard split of profits: 25% Mary C. / 75% Instructor *