Please print this form, fill it out and send to: 

Maggie Gaffen
SLAPSTICON 
Arlington County Cultural Affairs
3700 South Four Mile Run Dr.
Arlington, VA 22206 
 
 

NAME: _____________________________ 

STREET ADDRESS: _____________________________ 

CITY: ________________ STATE: ____ ZIP: __________ 

COUNTRY: ______________________________ 

E-MAIL: ________________________________________ 

TYPE OF REGISTRATION
(Please indicate the number of registrations next to each type.) 

_____ Full Four-Day Registration @ $99 

_____ One-Day Registration(s) @ $30 Date(s): ________ 

_____ Half-Day Registration(s) @ $16 Date(s): ________ 
 

ADDITIONAL NAMES OF THOSE ATTENDING:

__________________________________________________

__________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

NOTE: Children under 12 admitted free
 

FORM OF PAYMENT

CREDIT CARD

Payment can be made using your MasterCard or Visa card.  To do so, please complete the following:

TYPE OF CARD (check one):  MasterCard _____  Visa _____
NAME ON CARD: ___________________________________________
ACCOUNT NUMBER: ___________________________________________
EXPIRATION DATE: _________________________
TOTAL TO BE CHARGED:  $___________________
SIGNATURE: ________________________________
 

CHECK

You can also make payment using a check or money order made out to "Treasurer, Arlington County." 

TOTAL ENCLOSED: $___________ 

NOTE: If you have questions about registration, you can send an email to mgaffen@arlingtonva.us or call Maggie Gaffen at 703-228-1841.