Bob Ross - Rolling Hills (Paragould & Pocahontas)

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form to begin your registration.

Registration is only complete once payment of $65.00 is received in full. Payments must be made in person or by credit card. Payments cannot be made online.

Payments by credit card may be submitted by phone at 870-248-4180 or 870-248-4000, Ext. 5100.

Registration deadline is Tuesday, September 3, 2024.

Class will be held on Saturday, September 7, 2024.

Email *

Record my email address with my response

This workshop is being offered at two different times and locations on the same date. You are registering for which time/location?

9:00 a.m. - BRTC, Paragould, Room 107

2:00 p.m. - BRTC, Pocahontas, Room 113

Clear selection

First Name *

Middle Name *

Last Name *

Mailing Address

(Example: 1234 Test Way)

Mailing Address

(Example: Pocahontas, AR 72455)

Date of Birth *

YYYY

Sex: *

Male

Female

Prefer not to say

Phone Number (Ex: (555-555-5555) *

Email Address *

How did you hear about this class? *

Newspaper

Flyer

Website

Social Media

Radio

Word of Mouth

Chamber of Commerce

Other

Clear form

Never submit passwords through Google Forms.

This form was created inside of Black River Technical College.

Does this form look suspicious? Report

Forms