SOSI: October Class Series
Rocker's Name
*
First Name
Last Name
Age
*
Instrument
*
Please Select
Keyboard
Electric Guitar
Bass
Parent/Legal Guardian Name
*
First Name
Last Name
Parent/Guardian E-mail Address
*
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Do you need to borrow an instrument
Yes
No
Please describe past musical experience:
If this is your first time in a She Rock class, how did you hear about us?
Payment- $179
Note: In the event you need to cancel, you must notify us by September 24th to receive a refund (less a $25.00 deposit).
Participant Name (this helps with our records)
*
Payment options
*
Paypal
Check
Pay by Check:
Please mail your check for $179 to: She Rock She Rock, 5115 Excelsior Blvd #316, Minneapolis, MN 55416. Checks must be received within three (3) business days of registration in order to hold your spot.
Pay by Paypal:
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SOSI: October Class
$
179.00
Tax deductible donation to help economically-challenged girls and women attend our programs
$
1.00
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