Band Camp Registration Form

Participant's Name:*

First Last

Is the participant bringing a spouse/guest?*

No
Yes

(NOTE: Guests may sign up for complimentary non musical classes the first day of camp. If your spouse/guest plans to play in the camp music program, they must register separately.)

Spouse/Guest's Name:*

First Last

Participant's chosen name for name tag:*

Spouse/Guest's chosen name for name tag:*

Email Address:*

Phone:*

Emergency Contact Phone:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Band Level:*

Select Your Instrument:*

Your OTHER Instrument:*

Daily 9:45-10:45 Classes—Select One*

(NOTE: Jazz I & II are the same class. Only sign up for One. The same goes for Handbells I & II.)

Daily 11:00-12:00 Classes—Select One*

Payment Method:*

Paypal/Online
Check

Select One:*

Current NHIMA Member ($170)
Current NHIMA Member ($170 + Guest $55 = $225)
Non NHIMA Member ($190)
Non NHIMA Member ($190 + Guest $55 = $245)

(NOTE: Guests are an additional $55.00)

Select One:*

Current NHIMA Member ($170)
Current NHIMA Member + Guest ($170 + Guest $55 = $225)
Non-NHIMA Member ($190)
Non-NHIMA Member + Guest ($190 + Guest $55 = $245)

(NOTE: Guests are an additional $55.00)

Total

$0.00

You have chosen to pay by check. Please copy the information below before clicking the submit button at the bottom of this form. Payment is due immediately to complete your registration.

Make checks payable to:

West Michigan New Horizons Music Ensembles
1200 28th St. SE
Grand Rapids MI 49508

Any Questions?

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