Center for Creative Expression request for information form

Center for Creative Expression
Request for Additional Information

Are you interested in Art, Dance, Music, Drawing, Sculpting, Painting?

The Center for Creative Expression, a program of the Rehabilitation Research & Training Center on Community Integration of Persons with TBI, is providing classes for persons with traumatic brain injury (TBI), at the Multi-Service Center at 1475 West Gray. Each class will meet 12 times over several months and all are free of charge.

Complete this on-line form and hit the submit button or print out this form and mail or fax it to the address below and we will contact you with more information about which classes are being offered and how to sign up for a class. You may also contact Terri Hudler-Hull by e-mail at the address below.

Name:
Address:
City:
State:
Zip Code:
Telephone:
E-mail:
Interests:	I am interested in: (please check all the boxes that apply)
	Dance/Movement Mosaics Drums Painting Creative Writing Drawing Collage Music Poetry Paper-Maché Sculpting Pottery Singing Water Color	Self Portraits Rhythm and Percussion Folk Art Photography Clay Drama/Acting Calligraphy Decoupage Stamp Art Macramé Mask Making Craft Art Stenciling Weaving

Terri Hudler-Hull, MS
Sr. Project Coordinator
Baylor College of Medicine &
Memorial Hermann|TIRR
Brain Injury Research Center (BIRC)
2323 S. Shepherd, Suite 907
Houston, TX 77019-7022
713.630.0526, 713.630.0529 (FAX)
terri.hudler-hull@memorialhermann.org

Upated: 2/12/08