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Summer Keyboard Institute (SKI) Registration Form

June 22-27, 2014


Parents
Full payment of Balance Due will be charged to your credit card when you complete this form and submit your credit card number.

For Check payments, complete this form, submit, then print a copy to mail to the camp along with your check.
Checks payable to FURMAN UNIVERSITY.
Check applications are not considered until payment arrives.

Mailing Address for checks:
Summer Keyboard Institute
Furman University
3300 Poinsett Highway
Greenville, SC, 29613

Financial and Refund Policy

Questions? call 864-294-2086 or email furmanmusic@furman.edu

Student Information

Student First Name:
Student Middle Name:
Student Last Name:
Student Preferred Name:
Gender:
Home Address:
Address 2:
City:
State:
Zip Code:
Home Phone:
Student Cell Phone:
Student Email:

Primary Area of Study:
Secondary Area of Study:
Piano Masterclass Performance:
Years of Experience on piano: years
Years of Experience on organ: years
Private Teacher's Name:
 
Student Age as of June 1, 2012:
Have you attended this institute before?
If yes, what year(s):
What school do you currently attend?
What grade are you currently in?
Music Honors and Awards
T-shirt size (adult sizes):


Parent Information

Parent First Name:
Parent Last Name:
Parent Email:
Parent Work Phone:
Parent Cell Phone:
Payment Type:


Costs

Basic Cost:
Add Private Lessons:
(Note: Limit a total of four lessons.
You may mix and match
within the four options.)
Piano:
Organ:
Music Technology:
Improvisation:


Discounts

$75 Discount for Siblings:
(Available if two or more of your children are applying to attend this summer.
Submit separate applications for each child. $75 discount applies for EACH child.)

Yes, I qualify for the Sibling Discount
List names of siblings so we can verify:   
 
$75 Furman Employee Discount:
(Available to children of Furman faculty and staff)
Yes, I qualify for the Furman Employee Discount
Furman Dept and Phone Ext:   


Scholarships

If your student earned scholarship(s) to attend the institute this summer, please list details below.
ONLY INCLUDE HERE IF AWARD IS CONFIRMED and the check will be mailed to Furman.
Scholarship checks are due to Furman no later than May 15. Please be sure the presenter of your scholarship is aware of that deadline. Checks should be made payable to Furman University and mailed to the address below.
Scholarship 1 Amount: $
Scholarship 1 Presenter and Phone #:
Scholarship 2 Amount: $
Scholarship 2 Presenter and Phone #:


Totals

Costs Subtotal: $
Discounts/Scholarships Subtotal: $
Total Amount Due: $
  

IMPORTANT FOR CREDIT CARD PAYMENTS: After clicking the submit button, it is necessary to continue through the next 3 pages beyond "The Confirmation of Payment" page, until you are returned to the Transaction Results page. This will ensure that the transaction is complete.