| Name | |
| Address | |
| Address 1 | |
| City | |
| State | |
| Zip Code | |
| Are you employed as a music teacher? |
Yes No If so, where? |
| Home Phone | |
| Work Phone | |
| If you are requesting college credit for any workshop, please supply this additional information as well. | |
| Date of Birth | |
| Social Security Number | |
| Are You A U.S. Citizen |
Yes No |
| If you are not a U.S. Citizen, please provide: | |
| Country of Citizenship | |
| Non-resident alien, type of Visa | |
| Permanent U.S. resident alien, Reg # | |
| Have you ever attempted a credit course at SMU? |
Yes No |
| If you answered "yes" to the previous question, in what semester and year were you last registered? | Semester Year |
| What was the last degree you earned, and where did you earn it? | Degree From |
| Ethnicity (optional): | |
| Orff Schulwerk, Levels I, II, III |
|
| Registration confirmations are sent by e-mail. To what e-mail address would you like yours sent? | |
| Payment Method | |
| Purchase Order Number (please include P.O. copy with registration) | |
| Credit Card name on card: |
|
| CVC code (3 digit security number on back of card) | |
| Credit Card account number: |
|
| Credit Card expiration date: | |