SUMMER 2017 REGISTRATION

Student Name:

Age:

Instrument(s):

2016/2017 NYSSMA level:

Most Recent Piece Studied:

Private Teacher's Name:

Parent Name(s):

Address:

Home Phone:

Cell Phone:

E-mail:

Emergency Contact Name:

Emergency Contact Phone Number:

Tuition for 2017: (please choose one option)


Need-based scholarships are available. Please contact Kirsten Lonnie, Executive Director of Southampton Cultural Center at 631-287-5676 or klonnie@scc-arts.org to apply. Scholarships are limited and will be awarded on a first come, first served basis as funding allows. Please apply as early as possible for consideration. If you would like to make a donation toward our scholarship fund, please click on the donate link above.

Preferred Payment Type:


Credit Card Information*
Name On Credit Card:

Credit Card Number:

Expiration Date: Month: Year:

Security Code:

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