| Father's Name____________________________________________ |
| |
| Mother's Name___________________________________________ |
| |
| Instrument/Voice – Current School/Instructor: |
| |
| _______________________________________________________ |
| |
| Previous Study: Instrument/Number of Years/Instructor(s): |
| |
| _______________________________________________________ |
| |
| Registration
Fee: |
$30.00 individual/$45.00 family
per year________ |
| |
|
| |
Class Tuition: ______________ |
| |
|
Make check
payable to: CMS |
Amount Enclosed: _____________ |
|
| |
(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
|