You can register one of two ways:

Call 859-273-9991 to register over the phone with your Visa or Mastercard. 

Print off this page to fill out the form; mail, fax (859-273-8195) or drop off the completed form.    Please make checks payable to Music Institute of Lexington.

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General Registration

Sign up for:	Price
□ Camping at the Seashore	$75 + $30
□ Family Music: Twist and Turn	$75 + $30
□  Petite Pianists: Beginners	$100+$30
□ Petite Pianists: Advanced	$100+$30
□ Beginning Guitar Class (six weeks)	$112.50
□ Rock Band Coaching (per band); eight weeks	$250
□ Weekly Private Lessons: 8 thirty-minute lessons Instrument:_________________________________	$216
□ Weekly Private Lessons: 8 forty-five-minute lessons Instrument:________________________________	$322
□ Weekly Private Lessons: 8 sixty-minute lessons Instrument:________________________________	$367

Subtotal: _________________                           

Registration Fee:  $10.00                                     

Total: ____________________                          

Student's Name: _____________________________________________

Age: _____   Birthdate:________  □ Male  □ Female

Parents' Names: ____________________________________________

Address: __________________________________________________

City: __________________________  State: ______  Zip: ___________

Home Phone: __________________  Work Phone: _________________

Cell Phone: ____________________  Email: ______________________

Method of Payment: □ Check  □ Visa/MasterCard                                       

Card #: _____________________________Expiration Date: _________

Authorization to charge credit/debit card:

Signature: ________________________________________________