Name________________________________________________________________________

Email Address: ________________________________________________________________

Home Phone_________________________________ Work Phone_______________________

Address_____________________________________________________________________

City_________________________________ State______________ Zip___________________

Place a check in the box of each workshop in which you desire to enroll:   Introduction to Orff Schulwerk Kodály Certification Training*:        OPTION I (June 29-July 17 at UNT)            Level I            Level II            Level III        OPTION II (June 29-July 11 at UNT; 7 Saturdays in PISD)            Level I            Level II            Level III Instrument Repair for the Busy Band Director Orff Schulwerk Certification Training, Level I *Please note: Level I is a prerequisite for Level II and Level II is a prerequisite for Level III. If you have completed previous levels of Kodály training at a school other than UNT, please list the school name here: ___________________________________________ I plan to enroll for graduate credit in the following course(s) ______________________________________________ ______________________________________________ WORKSHOP FEES DUE: A minimum of $50.00 must be submitted with the registration form for EACH workshop in which you enroll. Note: This $50.00 will be applied toward the total amount. A non-refundable deposit of $50.00 will be retained if you cancel your enrollment in a class. AMOUNT ENCLOSED: ___________________________________________ BALANCE OWED: _______________________________________________

$300.00 $600.00 $300.00 $600.00

PAYMENT METHOD: Check (Payable to UNT) Visa Mastercard If paying by credit card: Credit Card Number:________________________________ Expiration Date: ____________________________________ Name on Credit Card: (Print) ________________________________________________ Signature_________________________________________ Billing Address, if different from address above: ________________________________________________ ________________________________________________ Note: A $15.00 processing fee will be added to all credit card transactions. CONFIRMATION OF YOUR REGISTRTATION WILL SENT TO YOU VIA E-MAIL.  BE SURE THAT YOU HAVE PROVIDED AN E-MAIL ADDRESS TO WHICH YOU WILL HAVE ACCESS DURING THE SUMMER MONTHS.