COMMUNITY MUSIC SCHOOL
LEHIGH VALLEY
REGISTRATION FORM FOR CLASSES (html)
 
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Student Name:
Last__________________________ First______________________
 
Address:

Number & Street__________________________________________
     
City________________State_____   Zip____________________
     
Telephone:    
Day__________________________   Evening________________
     
Email:________________________    
     
Age:___Date of Birth:___________   School-Grade_____________
     
Father's Name____________________________________________
 
Mother's Name___________________________________________
 
List class(es) you are registering for:
1. 2.
3. 4.
 
Registration Fee: $10.00 per year________________
   
  Class Tuition: _________________
   
  Amount Enclosed: _____________
 
Make check payable to: CMS
(Please circle one)  
MC, Visa, Disc, AmExp Card # __________________________
Exp Date: ____________ Zip Code ________________________
 
Signature: ______________________________________________
 
Mail Form to: Community Music School (610-435-7725)
23 N. Sixth Street, 2 nd Floor, Allentown, PA 18101