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)

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.

*Please make sure all (required) fields are completed before pressing ‘Submit’

Holy Names Music Center