The Philadelphia International Music Festival Summer Camp Winter Camp Registration Form

Sixth Annual PIMF Intense Solo Performance Program in Miami, Florida

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:

*December 17th, - December 22rd , 2012*			Please Select a Session:
Tuition: $1,950.00 - Includes a $200.00 non-refundable deposit.
Commuters: $1,850.00: (8:30 a.m. - 9:00 p.m.) Includes all music instruction, lessons, meals and activities.
Guests are welcomed to join us for dinner at a cost of $15.00 per meal.
Extra Private Lesson Fee: $85.00 per lesson All campers receive three lessons as part of the tuition payment. This fee is for additional lessons ONLY. Students may purchase up to two additional lessons.
TOTAL Required Fees:
Note: A $200 non-refundable deposit is required. Campers MAY pay in full: Balances are due on 12/01/12
Credit Card Information Credit Card and Payment Information Note: All registration require a $200 non-refundable deposit. Registrations without deposit information will not be processed. Balances not on a payment plan are due in full by 12/01/2012. 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 or Six month no interest monthly payment plans: Your balance after the required deposit will be divided by the 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? Yes No 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? Yes No If you have attended PIMF, when? Check all that apply. 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Comments, Questions, or Special Requests: