Lilac City Community Band Registration Form Payor Name(required) Phone Number(s)(required) Email(required) Complete Mailing Address (Street #, City, ST, Zip)(required) If new, How did you hear about us? LCCB Member Name(required) Birthday Instrument(required) Discounts: 2 or more family members are $50 per quarter. Please note: There is a $2 processing fee for credit card payments. Session Sign Up:(required) Winter only ($35) Spring only ($35) Summer only ($10) Winter + Spring ($60) Winter + Spring + Summer ($70) Spring + Summer ($45) Additional Family Member(s) (include name(s), birthday(s) + instrument(s), alternate contacts if applicable) Copy & paste into text field if easier Electronic Signature of Person Responsible for Payment (Type Name) I have read and agree to the rates info and policies of HNMC(required) The HNMC office will email confirmation of receipt & contact for payment within 1-2 business days. Submit Δ *Please make sure all (required) fields are completed before pressing ‘Submit’