mail to:   The Salisbury School of Music, 213 S. Main Street, Salisbury, NC 28144

REGISTRATION FORM
Please enclose $10 registration fee. The fee will be refunded if we
are unable to provide an instructor for your instrument of choice.

Please complete a separate form for each student.  

Todayıs date:   ____/____/____

Student Name: __________________________________ 
Birth date: ____/_____/_____
If student is a minor, parentıs name: 
____________________________________
Address:   
street :_______________________________________________________
city: _____________________________________ 
state: _________ zip __________
home phone #: ____________________ work phone #: 
____________________
e mail: _________________________
You are requesting lessons in which of the following: (please circle)
piano      voice      guitar     other__________________________________

Please check the type of lesson you are requesting:
The price indicated is per lesson

_____ Private, 30 min. ($18)    ____ Shared, 2 students, 30 min. ($10)*
_____ Private, 45 min. ($27)    ____ Shared, 2 students, 45 min. ($15)*
_____ Private, 60 min. ($36)    ____  Shared, 2 students, 60 min. ($20)*
_____ Private, 20 min. ($12)    ____ Class, 3-5 students, 60 min. ($16)
        (ages 7 & under only)

*Students in shared lessons or classes need to be of similar level of
ability.  These lessons will only be available when the student  can be
matched with another student.  If you are signing up with another
person with whom you wish to share a lesson, please indicate that
below:

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