Conservatory of Music Registration

Name*

First NameLast Name

Please indicate all that apply:*

If there are special circumstances you need to inform the Conservatory about, please use the text box below:

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email address*

example@example.com

Home phone number*

Area CodePhone Number

Cell phone number*

Area CodePhone Number

If younger than 21, enter birth date

Date

Grade in school

Employer/position or school name

Employer or school phone number

Area CodePhone Number

If the student is under 21 years of age, please complete the following:

Father/Guardian

First NameLast Name

Father/Guardian's cell phone number

Area CodePhone Number

Father/Guardian's work phone number

Area CodePhone Number

Father/Guardian's email address

example@example.com

Father/Guardian's employer and position

Mother/Guardian

First NameLast Name

Mother/Guardian's cell phone number

Area CodePhone Number

Mother/Guardian's work phone number

Area CodePhone Number

Mother/Guardian's email address

example@example.com

Mother/Guardian's employer and position

Instrument

Years of study

Teacher request (if any; for listings, see faculty listed online)

Lesson length (minutes)

304560

Please check all days you are available for lessons

Please indicate times available on the above days and indicate your first choice

Title

Refund/Make-up/Withdrawal Policy

Refunds, credits, or make-ups cannot be given for lessons missed by the student. I understand and accept the conditions for registration/withdrawal as outlined on the Millsaps Conservatory website. Signature required below.

E-signature*

Please use your mouse, trackpad, or finger on your touchscreen to sign.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

To pay by check, please send in a check made out to Millsaps College to:

Millsaps Conservatory of Music
c/o Rachel Heard, Millsaps College
1701 North State St
Jackson, MS 39210

To pay by credit or debit card, please select the option below:

Check box to pay online

Choose one option:

Conservatory of Music Master Teacher Lessons$645.00

Length of Lesson

Conservatory of Music Student Teacher Lessons (Please confirm with the Conservatory before selecting this option!)$310.00

Length of Lesson

Conservatory of Music Musicianship Class$210.00

Conservatory of Music Small Group Ensemble$260.00

Total $0.00

Credit or Debit Card

Conservatory of Music Registration

Student Information

Private Lesson Requests

Class or Group Requests

Billing Information

Credit or Debit Card