Music Theory On Line - Course Registration

Music Theory On Line
Course Registration

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 *	ааааа
State *	а
Zip
Country
e-mail *
Birth Date *
(Please use 6 digits - for example 010199 for 01/01/99)
Parents, please insert initials here for permission to transfer above data: а

Please choose a method of payment *

Pay by CHECK

Pay via PayPal (secured transaction)

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