Class Registration Form

Register at least 7 days before your class begins to qualify for Early Bird Pricing. Remember if you register past the Early Bird date, your credit card will be charged the regular class price.

Please note: When you are a Swallow Hill Member you will enjoy discounts on all registration prices. Otherwise, your credit card will be charged the regular class price.

Class: Music For the Dyslexic and Learning Disabled

Instructor: Sina McOwens

Date/Time: Saturday, 5/10, 1-3pm

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

Address:
City:
State:
Zip Code:
Phone 1:	Ext:
Phone 2:	Ext:
Email:
Confirm Email:

Which price to I qualify for?

Tuition:	$
Materials Fee:	$
Registration Fee:	$
Total Charge:	$