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Northwest Missouri State University


Music Camp Registration

*All fields are required

Camper Information
Student First Name:
Student Last Name:
Gender: Male     Female
Address:
City:
State:
ZIP Code:
Student Email:
Home Phone:
Work Phone:
Parent/Guardian Name:

School Information
Birthdate: (format: MM/DD/YYYY)
Age:
School:
Grade Level: (for this past school year)
Years Attending NW's Camp: (including this year)
Instrument: (be specific)    Years Played:
Voice Type: (be specific)      Years Sung:
All-District:         State: 
All-State:         State: 

Camp Information
T-shirt Size: (included in camp fee)
Roommate Preference:
Camp Preference: SENIOR HIGH BAND (Grades 9-12)
SENIOR HIGH CHOIR (Grades 9-12)
Camp Preference: MIDDLE SCHOOL BAND (Grades 6-8)
MIDDLE SCHOOL CHOIR (Grades 6-8)

CAREFULLY CHECK YOUR CHOICE OF THE FEE PLAN
$395 - Complete Package
6 days, 5 nights, 15 meals, dorm room, instruction, health fee and recreation
$330 - Day Camper (for local residents)
same as the "Complete Package" plan, but without dorm room, 8:30 a.m. - 9 p.m.

Are you interested in including a lesson (for an additional fee) with your camp plan?

30-minute lesson ($20)      60-minute lesson* ($40)      none

Payment Information

 

Payment Type: Credit or Debit Card
Cash, Check or Money Order
Camp Fee: $
Scholarship Discount: $
Total Due: $
Paying Today: $ ($50 min. deposit required)
Remaining Due: $ (total due by May 26, 2012)

 

Billing Information
I would like to use the address information for the billing address.
Yes     No
*First Name:
*Last Name:
*Street Address:
*City:
*State:
*ZIP Code:
*Phone:
*Email Address:

To retain a copy of this application for your records,
PLEASE PRINT THIS PAGE NOW!