PIMF Groznjan/Italy Festival & Tour Registration Form: July 29 - August 12, 2012
Last Name:
First Name:
Age as of 6/21/2011:
Date of Birth: (MM/DD/YYYY)
Gender:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Country:
Home Phone:
Cell Phone:
Name(s) of Parent(s) or Guardian(s):
Parent(s) E-mail Address:
Registrants E-mail
School Attending:
Grade as of 9/01/2011:
What is your primary Instrument:
What is your secondary Instrument:
Private Teacher Name:
Private Teacher Phone:
School Orchestra:
Other Orchestra:
Other Orchestra Director Name:
Other Orchestra Director Phone:
List current solo repertoire:
List past two pieces learned:

DEPOSITS: All registrations require a $200 non-refundable deposit.
CANCELLATIONS - All deposits are non-refundable and non-transferable. If a cancellation is made prior to May 1, 2012, full payment (less a $200 deposit) will be refunded or may be applied toward another camp session should there be space available. No refunds or credits will be issued after May 1, 2012, except in the case of a medical emergency. No refunds are issued for any late arrivals or early departures from any one week or two week camp session.
Tuition: - Includes a $500.00 non-refundable deposit and airfare
Required Insurance:
Total Required Fees

Credit Card and Payment Information

CANCELLATIONS - All deposits are non-refundable and non-transferable. If a cancellation is made prior to May 1, 2012, full
payment (less a $200 deposit) will be refunded or may be applied toward another camp session should there be space available.
No refunds or credits will be issued after May 1, 2012, except in the case of a medical emergency.

Card Type: Credit Card Number:

Exp. Date (MM/YYYY): Mo. Year

Would you like to pay the amount due in full now? Yes No

Three, six or nine month no interest monthly payment plans: Your balance after the required deposit will be divided by the length of the plan that you choose. Your credit card will be charged monthly on the day that you choose below until the balance is paid. Your payment plan will begin on the payment date nearest your registration date. You will receive a statement via email showing your current balance each month.

Are you interested in setting up a monthly payment plan?

Please Choose a Payment Plan Length Please Choose a Payment Plan Date

Additional Information

How did you hear about the Philadelphia International Music Festival?

Have you attended PIMF in previous years?

If you have attended PIMF, when? Check all that apply.
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