2019 Eastman Rochester New Horizons Summer Session Registration Form

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Gender

Male
Female

Date of Birth*

Preferred Phone*

Email*

Emergency Contact Name*

First Last

Relationship to you*

Phone*

Music Information

What instrument do you want to play at this session?

How many years have you been playing this instrument?

In which ensembles do you currently play?

At approximately what Suzuki or NYSSMA level do you play?

If you are not sure, please name 1-2 pieces you are currently playing:

If you also play piano, would you be willing to play the piano part of a performance piece?

Yes
No

Housing Worksheet

Please indicate which type of room you would prefer. Costs are per room and total costs for the duration of the camp.

PLEASE CHOOSE ONE OPTION:*

I am not a musician but will attend with spouse/partner. (Please write their name in space below for "2 people"). I will not be charged for instruction, but only for meals and room.
I will not be staying on campus. Instruction and meals - $315
Room with private bath, 1 person (includes instruction and meals) - $410
Room with private bath, 2 people (includes instruction and meals) - $370
Room with shared bath, 1 person (includes instruction and meals) - $395
Room with shared bath, 2 people (includes instruction and meals) - $360

If you chose "2 people" in your room, name of person with whom you are sharing:

Are you a member of NHIMA?

Yes
No

Payment Agreement:*

I understand that the University must receive the full amount due (as described in this form) before the program start date, and that if full payment is not received by the due date, I may not attend the program. I understand that I am responsible for notifying the Bursar’s Office if my billing information changes at any time, and that payment must be in U.S. dollars.

Name:*

(your typed name indicates your agreement)

Date

Thank you!

Once we have received and processed your registration, you will receive an invoice from us. Payment must be made by April 15. If you are not able to pay by April 15, please contact Susie Truesdell at 585-857-0243 or struesdell01@gmail.com to make other arrangements.

2019 Eastman Rochester New Horizons Summer Session Registration Form