OCTOBER 2017 PERLMAN COLLABORATION

    Student Name:

    Age:

    Instrument(s):

    Parent Name(s):

    Address:

    Home Phone:

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    E-mail:

    Emergency Contact Name:

    Emergency Contact Phone Number:

    Tuition for the October Perlman Collaboration is $100.00
    Preferred Payment Type:


    Credit Card Information*
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    Expiration Date: Month: Year:

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    Credit Card information will be processed once the application has been reviewed and approved.

    Comments:

    Please mail checks to: Southampton Cultural Center, P.O. Box 5008 Southampton, NY 11969
    Please make checks payable to Southampton Cultural Center

    631-287-5676stringsfestival@scc-arts.org