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Program Registration Form
Registrations may be faxed to 270-745-8974. To register by
mail, complete the following registration form and send with payment to: Continuing Education, 2355 Nashville Road,
Bowling Green, KY 42101. In the
past, we have taken registrations by phone.
However, due to the time this takes (as well as increased chance of
errors), this will no longer be an option. We apologize for any inconvenience
this may cause.
Name ________________________________ SS#___________________ DOB____________
Male___ Female___ Parents ___________________________________________________
Address _______________________________________________________________________
City __________________________________ State _________ Zip Code __________________
Home phone ___________________________ Work phone_____________________________
Cell phone ____________________________ Cell phone 2 ______________________________
Email __________________________________________________________________________
Add’l contact person __________________________________ Relationship ________________
Phone numbers __________________________________________________________________
**15 30-minute lessons + group
classes $337.50 15 45-minute lessons + group
classes $506.25 15 60-minute lessons + group
classes $675
Violin/Viola /Cello/ Fees
Registering for: Violin/Viola ___ Cello ___
*Lesson Length: 30 min. ______ 45 min______ 60 min______
Lesson Start Date ________________________________
___ Yes, my child will participate in the included group/chamber music enrichment classes.
___ No, my child will not be participating in the included group/chamber music enrichment classes
Payment Information for Fall 2006 Lessons
_Cash _ Check (payable to WKU) _Discover _MasterCard _Visa
Payment included is for: _Full Amount _Half Tuition, other half will be paid by October 4, 2006
***If credit card: Name on card _________________________________ Exp. Date ______________
Card Number_______________________________________________________________
*All
beginning students will begin with a 30-minute lesson. As the student progresses, the teacher will
discuss a longer lesson length. The
instructor will contact you regarding lesson time once your registration has
been received.
***If
paying by credit card, please be aware that we will not run your credit card
for the second payment unless you notify us and make that request.