Millersville University Summer Music Camp Registration

Millersville University Summer Music Camp Registration

June 23-29, 2013
All Items MUST be filed out to process registration
STUDENT CAMPER INFORMATION
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2 in needed

CityState / Province

Postal / Zip CodeCountry
E-mail
Best Phone Number

Area CodePhone Number
Birth Date

MonthDayYear
Age
Gender
Grade completed at time of camp
High School
Do you study privately?
If yes, provide your private teacher's name here:
Do you have a roommate request?
If yes, provide the name of your requested roommate here:
Primary Instrument
If voice is your primary instrument, what is your voice type?
Secondary Instrument
If voice is your secondary instrument, what is your voice type?
First Choice Elective:
Second Choice Elective:
T Shirt Size
PARENT/GAURDIAN INFORMATION
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Area CodePhone Number
Cell/Alt. Phone Number

Area CodePhone Number
E-mail
PAYMENT INFO

IF PAYING BY CHECK, PLEASE USE THE "PRINT FORM" BUTTON BELOW AND THEN HIT SUBMIT FOR THE MAILING ADDRESS FOR YOUR FORM AND PAYMENT. IF PAYING BY CREDIT CARD, LEAVE THE QUESTION BELOW BLANK AND SIMPLY CLICK SUBMIT. YOU WILL BE PROVIDED WITH A LINK TO OUR ELECTRONIC PAYMENT PAGE.
Select Appropriate Amount
Should be Empty:

STUDENT CAMPER INFORMATION