THE CHICAGO SCHOOL FOR PIANO TECHNOLOGY

2041 W. CARROLL AVE. SUITES 227-229

CHICAGO, IL 60612

312/666-7440 or email chipianoschool@aol.com

SEMINAR REGISTRATION

 

Seminar Date:

Full Name: __________________________________________

Full Address: ________________________________________

                       ________________________________________

Telephone #   ________________________________________

Email              ________________________________________

Advanced Registration Cut-Off Date:

Seminar Cost: $125.00 (Advance Payment) $140.00 (At the Door) Lunch included   

Paying by: Cash___Check__Credit Card (Visa/MC only)___ If by Credit Card:

Card Name__________Card #_____________________Exp. Date_____

(NAME AND ADDRESS MUST MATCH CREDIT CARD BEING USED)

Signature____________________________________________________

Please mail this registration form to the address above with your check made out to The Chicago School for Piano Technology or with the appropriate credit card information.