UNIV E RSIT Y OF MON TANA
2016 Summer Music Camp Registration
String Camp
First Name
Last Name
Birthdate
Gender
Male
Female
Street Address
City
State
Camper Cell Phone
Camper Email
Main Instrument
Zip
Orchestra Section: (violin I , violin II etc)
8
Grade Fall 2016
TH
9
TH
10 TH
11 TH
12 TH
Recent HS Graduate
School Name
Orchestra Director
Private Teacher
Are you applying with
other chamber members?
Yes
No
Add names of your group members (use a separate sheet if you have to):
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 your paid deposit. 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)
Camper must have participated in one of the following during
the 2015-2016 School Year to be eligible.
(Optional) On-Campus meal plan
Lunch Only M-F($44)
Lunch/Dinner M-F($89)
Less Scholarship-if applicable
MCPS: All-City Orchestra ($25 off)
UM All-Star Ensemble ($50 off)
All-State ($50 off)
All-Northwest ($75 off)
-$
(Eligibility will be VERIFIED BY UM)
Total Camp Tuition
Overnight Camp
Camp Fee
$460.00
(T- shi rt/ Photo/Room & B oard)
Less Scholarship-if applicable
-$
Total Camp Tuition
$
What Section?________________________
List your most advanced repertoire piece:
____________________________________
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)
Parent (please print)
Daytime Phone:
Email Address:
CVV #
S
M
L
XL
2XL
Evening Phone: