UNIV E RSIT Y OF MON TANA
2016 Summer Music Camp Registration
Band
First Name
Last Name
Birthdate
Male
Gender
Female
Street Address
City
State
Camper Cell Phone
Camper Email
Main Instrument
Zip
Second Instrument
7
Grade Fall 2016
TH
8
TH
9
TH
10 TH
11 TH
12 TH
RECENT GRAD
School Name
Band Director
Private Teacher
Cancellation Policy: Cancellations received prior to 5pm, Friday, June 3 will receive a full refund of all monies paid. Please allow 4 -5 weeks
for processing. Cancellations received prior to 5pm, Friday June 17 will receive a refund less deposit paid. After June 18, all fees paid will be
forfeited. For registration questions, please contact Kevin Griggs at (406) 370-8730 or via email at kevin .griggs@umontana.edu
Scholarships – MARK ONE ONLY
Day Camp
Camp Fee
$230.00
(T-Shi rt/photo)
(Optional) On-Campus meal plan
Lunch Only M-F($44)
Lunch/Dinner M-F ($89)
Camper must have participated in one of the following during the
2015-2016 School Year to be eligible.
Five Valleys Honor Band ($25 off)
All-State Band ($50 off)
UM All-Star Ensemble ($50 off)
All-Northwest Band ($75 off)
Less Scholarship-if applicable
-$
Total Camp Tuition
$
Camp Fee
$460.00
(Eligibility will be VERIFIED BY UM)
Overnight
(T- shi rt/ Photo/Room & B oard)
Less Scholarship-if applicable
-$
Total Camp Tuition
$
Scholarships – MARK ONE ONLY
Five Valleys Honor Band ($25 off)
All-State Band ($25 off)
UM All-Star Ensemble ($50 off)
All-Northwest Band ($50 off)
(Eligibility will be VERIFIED BY UM)
Send check or money order payable to “UNIVERSITY OF MONTANA” to the following address:
UM SUMMER MUSIC CAMP, SCHOOL OF MUSIC, 32 CAMPUS DR, MISSOULA, MT, 59812-7992.
Full camp information available at www. umt.ude/music under “Community.”
Master Card
Visa
Discover
Credit Card Payment
Charge Deposit only
Charge Full Tuition
Room Assignment
Credit Card #
Exp. Date
Please provide a contact number in case of questions regarding your account:
Signature:
To expedite the registration process, we will pre -assign roommates for our 2016 Camp. We encourage our students
to meet new people and make new friends. We will be assigning roommates by age. If your son or daughter would
like to room with a specific student, you must give us that in formation with this application. Once this application
is submitted, roommate preferences CANNOT be changed.
Roommates Name
(double-check spelli ng)
T-Shirt Size
( Adult)
S
M
L
XL
2XL
Parent (please print)
Daytime Phone:
Email Address:
CVV #
Evening Phone: