Adventures In Summer Music - Registration



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The personal information that you provide on this form is being collected under the authority of the Post-Secondary Learning Act and the Freedom of Information and Protection of Privacy Act of Alberta. It will be used by Continuing Education to facilitate the registration process for the Adventures in Summer Music Program. The information will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act of Alberta. The information may be disclosed to emergency medical personnel if necessary. The information will be retained in accordance with approved Information Management guidelines, after which it will be destroyed in a secure manner. If you have any questions about the collection and use of this personal information, please contact the Program Coordinator, Continuing Education, Red Deer College, Box 5005, 100 College Blvd, Red Deer, Alberta, T4N 5H5, Telephone: 403.356.4900.

REGISTRATION IS EASY!

• In person: contact the Registrar’s Office at Red Deer College

• Fax: 403.357.3660

• Mail: Red Deer College

100 College Blvd., Box 5005

Red Deer, Alberta

T4N 5H5

PERSONAL INFORMATION

|LAST NAME |FIRST NAME |MIDDLE NAME |

|      |      |      |

|DATE OF BIRTH (YYYY-MM-DD) |AGE |GENDER | MALE | FEMALE |

|      |      | | | |

|ADDRESS |CITY |PROVINCE |

|      |      | |

|POSTAL CODE |PARENT/GUARDIAN HOME TELEPHONE |PARENT/GUARDIAN BUSINESS TELEPHONE |

|      |      |      |

|EMAIL ADDRESS |

|      |

|Please indicate participant's T-shirt size (all sizes are ADULT) | Small | Medium | Large | X-Large |

COURSE INFORMATION (Choose course)

| |CRN # 176 |Band - Instrument rental required * |Tuition fee: $275.00 |

| |CRN # 177 |Band - No instrument rental required |Tuition fee: $250.00 |

|* Please note that we are unable to supply instrument rentals for baritone saxophones, bass clarinets, bass guitars, euphoniums or tubas. |

|For Band Students Only |

|What instrument will you play? |      |Number of years you have played your instrument? |      |

|Band you are applying for: | Introductory | Junior/Intermediate |

|Option choice for Junior/Intermediate band students only: |

| Woodwind Ensemble | Brass Ensemble | Percussion Ensemble | Jazz Band |

PAYMENT OPTIONS

| CREDIT CARD |Select card type: | VISA | MASTERCARD | AMERICAN EXPRESS |

|Card # |      |

|CARDHOLDER’S SIGNATURE |TODAY’S DATE |

|      |      |

| CHEQUE |ATTACHED |

| MONEY ORDER |ATTACHED |

|MAKE CHEQUES AND MONEY ORDERS PAYABLE TO Red Deer College |

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Red Deer College

100 College Blvd.,

Box 5005

Red Deer, Alberta

CANADA T4N 5H5

Telephone: 403.357-3663

Fax: 403.357-3660

Web-site: rdc.ab.ca/summercamps

ADVENTURES IN SUMMER MUSIC

REGISTRATION

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