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You may register several ways: By phone: Call 859-273-9991 to register with your Visa or MasterCard. By mail: Print off this page to fill out the form, and send care of
Please make checks payable to The Music Institute. By fax: Send to 859-273-8195. In person: Call 859-273-9991 to arrange a visit. General Registration Spring 2010
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: ________________________________________________
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