Attention Music Theory 099 is now accepting applications for student enrollment. Please Email the instructor if you have any questions concerning registration procedures. Parents of students age 17 and younger must give approval for this information to be transmitted. Please use the exact name as it would (will/did) appear on a college enrollment registration form and please do not change this name during the course unless first emailing instructor. There will be absolutely no resale or further use of this information, other than MTOL courses. A * means this section is required in order to send the form.   First Name * Last Name * Street Address * College Affiliation City *     State *      Zip *   Country e-mail * Birth Date * (Please use 6 digits - for example 010199 indicates January 1, 1999) Parents, please insert initials here for permission to transfer above data:   Please choose a method of payment * Pay by CHECK Please make a check for $139.00 - $89.00 if attending an affiliated school to: D.R. Parman and Associates 261 S State Road 135 Brownstown, IN 47220 An e-mail of confirmation will be sent upon receipt of check and the registration process will be completed. Pay by CREDIT CARD Please enter Credit Card Information below Name as it appears on card (ex. John Q. Public) Credit Card Number (no spaces or hyphens) Exp. Date (ex. 05/02) Credit Card Type (Visa and MC ONLY) Choose here Visa Mastercard The credit card above will be charged a total of $139.00 - $89.00 if attending an affiliated school. The charges will be in the name of Music Theory On Line.