Fleisher Art Memorial | Online Registration

Thank you for creating an account with Fleisher.

Please enter information for the primary account holder below. You will then have the opportunity to add additional contacts to the account.

If you would like to create a contact for a child, please complete this form for the parent, guardian, or caregiver first, and then select Add New Child to complete a separate form for them. We collect different information for each contact type, and appreciate your cooperation in keeping our records up to date.

Personal Information

Required fields are denoted by *--. You are in the Personal Information section. Continue to tab below to start reading or entering your information.

* What best describes your relationship to this account?

* How did you hear about us?

* First Name

* Last Name

Pronouns

Date of Birth

* Primary Phone (ex: xxx-xxx-xxxx)

Mobile (ex: xxx-xxx-xxxx)

* E-mail

Primary Address

--. You are in the Primary Address section. Continue to tab below to start reading or entering your information.

* Country

* State/Province/Region

* Address Line One

Address Line Two

* City

Postal Code

* Address Type

Account Information

Required fields are denoted by *--. You are in the Account Information section. Continue to tab below to start reading or entering your information.

* Username

* Password

* Confirm Password

Must contain an uppercase, three lowercase, a digit and a non-alphanumeric character (e.g. $ @ # %). Example "Abbbxx1#".

Demographics

Required fields are denoted by *--. You are in the Demographics section. Continue to tab below to start reading or entering your information.

Gender Identity

Which race or ethnicity best describes you?

Primary Language

Organization Name

Job Title

Demographic information is optional and may be compiled anonymously for grant applications to support programming.

Emergency Contact

Required fields are denoted by *--. You are in the Emergency Contact section. Continue to tab below to start reading or entering your information.

Emergency Contact Name

Emergency Contact Number (ex: xxx-xxx-xxxx)

Thank you for completing the above information. Submit this form in order to create your account. You may then add additional contacts, register for classes, make a donation or become a member!