PA Suzuki Teacher Training Registration Form 2023

PA Suzuki Teacher Training Registration Form
Name*

First NameLast Name
Gender*

MaleFemale
Age (On Jan. 1, 2023)*
Phone Number*

Area CodePhone Number
Emergency Contact Number during Institute week

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registration Fee (Determined by date you submit this form and we receive your payment)*
Course I am registering for:*
Would you like to order any Lunches?
Dorm Room (if applicable)
1 Free T-Shirt for each participant. Please pick size

Adult SAdult MAdult LAdult XL
Total payment due
*Please note that registration is not complete until payment is received.
I will make payment via:*

I will call the Moravian University Music Institute office (610-861-1650) with Visa or MasterCard informationI will fax (secure site) the payment information to 610-861-1657I will submit payment electronically via XMedius SendSecure, the secure file upload portal. Please see instructions belowI will submit a check via snail mail to: Moravian University Music Institute; Attn: PA Suzuki Institute; 1200 Main Street; Bethlehem, PA 18067
Questions, Comments
Cancellation Policy:
- 100% refund if requested four weeks prior to the first day of class
- 50% refund if requested less than four weeks, up to one week prior to the first day of class
- No refunds if requested one week prior to the first day of class
- Full refunds will be issued if course is cancelled by Institute
By pushing submit I hereby acknowledge that the information provided above is true and correct to the best of my knowledge. I also give the Institute photographer permission to take photographs of me to use for the Institute website/postcard and SAA
Should be Empty: