ITHACA COLLEGE CHAMBER MUSIC INSTITUTE 2000

Registration

Student Name  Last______________ First______________ Middle_______
Address  Street & No. ____________________________________________
         City, State, Zip ________________________________________
_Male  _Female   Age in July____        __Violin  __Viola  __Cello
Roommate preference (name and phone) _____________________________
T-shirt size (adult sizes) _S  _M  _L  _XL

Parent/Guardian

Name _____________________________________________________________
Telephone Day (___)________ Evening (___)________

Private Teacher

Name _____________________________________ Telephone (___)________
Address Street & No. _____________________________________________
        City, State, Zip _________________________________________

Application and Payment

Return this form with a deposit of $100, your cassette tape, and a letter of recommendation by April 1, 2000. Upon receipt of your application and deposit, we will send you confirmation of your registration. If you are accepted to the institute, we will bill you for the balance due. If you are not accepted, your deposit will be returned.

Application deadline: April 1, 2000
Final payment due by May 26, 2000
Late payment fee: $25

Please make your $100 deposit check payable to Ithaca College. Remit in U.S. funds only. Payment of deposit may also be made by MasterCard/Visa by using the authorization form below. Send to: Chamber Music Institute, Office of Conference and Event Services, Ithaca College, 201 Egbert Hall Ithaca, NY 14850-7071

MasterCard/Visa Authorization

Check one: __MasterCard   __Visa
Card number ________________________________ Expiration date ______
Print name as it appears on credit card ___________________________
Cardholder's signature _____________________________ Date _________