Class Registration Form

Class: Music in the Mountains Retreat

Instructor: Celeste Krenz and Friends

Date/Time: Thursday-Sunday, 7/12-7/15

Billing Information (Required)

Student Information (if different from Billing)

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone 1:	Ext:
Phone 2:	Ext:
Email:
Confirm Email:
	An E-Mail confirmation will be sent to this address.

Student Name use billing info

First Name:
Last Name:

Student Contact Info use billing info