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.

---

General Registration

Sign up for:	Price
□ Cycle of Seasons	$75+$25
□ Family Music	$75+$25
□ Twist and Turn	$75+$25
□ Camping at the Seashore	$75+$25
□  Petite Pianists: Beginners	$100+$25
□ Petite Pianists: Advanced	$100+$25
□ Weekly Private Lessons: 8 thirty-minute lessons Instrument:_________________________________	$200

 

MADcamp Registration
Check the box for the session(s) you wish to attend:	□ Session 1: July 7-11 □ Session 2: July 14-18 □ Session 3: July 21-25 □ Session 4: July 28-August 1
Check the box for the appropriate age group(s):	□ 4-6 year olds □ 7-9 year olds □ 10-12 year olds
Price per student per session: □ Additional fee for after-care (4-5pm)	$198+$25 $25

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: ________________________________________________