Camper Name: _________________________
Address: ______________________________
______________________________________
Camper email: __________________________
Parent/Contact Name: ___________________
Parent/Contact email: ____________________
Contact Phone: _________________________
Camper's Age: ______ Birth date: ____/____/____
Session First Choice: (please circle one)
July 7-11 / July 14-18 / July 21-25
Session Second Choice: (please circle one)
July 7-11 / July 14-18 / July 21-25
Camper's Primary Instrument: (please circle one)
Guitar / Bass / Keyboard / Drums / Brass/Reeds
Specify: ______________
Years of study on this instrument: ________
Camper's Secondary Instrument: (optional)
Guitar / Bass / Keyboard / Drums / Brass/Reeds
Specify: ______________
Years of study on this instrument: ________
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Payment Information
SIGN UP FOR 1 WEEK OR MORE!
Save on multiple week sessions:
1 week: $450 + $50 materials = $500
2 weeks: $825 + $50 materials = $975
3 weeks: $1200 + $50 materials = $1250
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You may pay by check or credit card (AMEX, MasterCard, VISA & Discover accepted). A non-refundable deposit of $150 per session is required with registration. Final payment is due by June 30, 2008. Cancellations made via written notice more than four weeks prior to the scheduled session are permitted, and are refundable, less the deposit. No cancellations are allowed, or refunds given within 4 weeks of the session.
My check is enclosed for: $ __________.00
Make check payable to House of Musical Traditions
Charge my credit card for: $ __________.00
Card: (circle one) AMEX / MasterCard / VISA / Discover
Card # ______________________________
exp. date: ____/____/____
Name on card: _________________________
Billing address: _________________________
_____________________________________
_____________________________________
Phone: ________________________________
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