MUSIC PREPARATORY SCHOOL, SPRING 2014 - PIANO. CONTINUING
STUDENT REGISTRATION FORM. Parent's/Guardian's Name: Home Address:
City:.
MUSIC PREPARATORY SCHOOL, FALL 2017 - PIANO CONTINUING STUDENT REGISTRATION FORM Student’s Name:
Age:
Parent’s/Guardian’s Name: Home Address: City: State:
Zip:
Home phone: Work Phone: Email: Preferred lesson day and time: I would like to continue my lessons for the fall semester with . (Instructor’s Name) Please choose your fee and remit payment. $380 for 15 (30-minute) lessons $560 for 15 (45-minute) lessons Payment Options: Please make checks payable to Bradley University. Credit Card:
Visa
MasterCard
Credit card number Signature Return to: Debbie Devine, Continuing Education Bradley University 1501 W. Bradley Avenue, Peoria, IL 61625 Email:
[email protected] / Phone: (309) 677-2820
Bradley University faculty and staff receive 10% off all fees. Please call Debbie at (309) 677-2820 for details. Discover
American Express
Expiration date
