GSM REGISTRATION FORM FOR THE LECTURES

ENROLMENT PROCEDURE:
1. FILL OUT AND MAIL / SUBMIT ONLINE THE GSM REGISTRATION FORM AT mmgorin@aol.com
2. SUBMIT PAYMENT BY CHECK (MAKE CHECK PAYABLE TO THE GORIN SCHOOL
OF MUSIC)
Register by October 20, 2008 for any or all of these events:
Please send a check to: The Gorin School of Music
2290 w. El Camino Real, Suite 6, Mountain View, Ca. 94022

NAME: __________________________________________________________________

YEARS OF STUDY (IF NOT A BEGINNER): __________________________________
WORK ADDRESS: ________________________________________________________
OCCUPATION: ___________________________________________________________
WORK PHONE NUMBER: __________________________________________________
E-MAIL ADDRESS: ________________________________________________________

HOME ADDRESS: _________________________________________________________
___________________________________________________________
HOME NUMBER: ______________________ CELL NUMBER: ________________
E-MAIL ADDRESS: ________________________________________________________

REGISTER FOR THE LECTURES:

INDIVIDUAL LECTURES FOR ADULTS: $ 18.00 X _________

INDIVIDUAL LECTURES FOR SENIOUR CITIZEN: $ 10.00 X ______

INDIVIDUAL LECTURES (CHILDREN): $ 5.00 X _________

CIRCLE THE DATES IF INDIVIDUAL LECTURE:

OCTOBER 25/08; NOVEMBER 8/08; JANUARY 24/09; FEBRUARY 14/09

PACKAGE FOR ADULTS: $ 60.00 X __________

PACKAGE FOR S.C.: $ 32.00 _________

PACKAGE FOR CHILD: $ 20.00 X

TOTAL REGISTRATION FEES: _____________________

Registration is complete upon
Receiving the GSM Registration Form and payment

FOR OFFICE USE ONLY

DATE OF STARTING AT GSM: