| Group Piano Spring Classes Registration Form |
Des Moines Symphony AcademyGroup Piano Registration Form - Spring 2008
Music for Moppets $180 (10, 45-minute sessions)
__ Wed. 10:30am Wed. 1:30pm __ Wed. 4:30pm __ Wed. 5:30pm
Music 1A $206 (10, 60-minute sessions)
__ Tues. 4:30pm __ Tues. 5:30pm __ Sat. 10:45am
Kinderkeyboard $206 (10, 60-minute sessions)
__ Tues. 6:30pm __ Sat. 9:30am
Music for Little Mozarts $125 (10, 45-minute sessions)
__ Wed. 11:30am Wed. 12:30pm __ Sat. 11:45am __ Sat. 12:30pm
Registration Information
Student ____________________________________________ DOB____________________
Parent _______________________________________________________________________
Phone Home ____________ Work ____________ Cell ____________
Mailing address ________________________________________________________________
City ________________________________________________ State _IA_ Zip ___________
Email address ________________________________________________________________
Payment Information Credit card Visa Master Card Credit card number: _____________________________________ Exp. Date ___________ Charge Amount: ___________
Check #: _______ Check Amount: _______
Date Received: _________ Date Processed: _________ Payment Date: _________ |