Registration

"*" indicates required fields

Playshops*

Your Information

Nickname

Name*

First Last

Organization

Address*

Street Address Apartment or PO Box City State/Province ZIP / Postal Code Country

Email*

Home Phone*

Mobile/Cell Phone*

Profession*

How did you hear about us?

Educational Credits

Continuing Education Units (CEU)

I would like to receive Continuing Education Credits

Type of CEU's*

$80 processing fee for 6-day Playshop
♦ additional fees apply, we will contact you to complete processing.

License Type*

CMT Number*

Discounts

Discount for DCFG conference attendees

I am also registered for the DCFG conference

Payment

6 Day Intensive Registration Fee

Price:

East Coast Mentor Experience Fee

Price:

CEU Processing Fee (6 Day Playshop)

Price:

DCFG Conference Attendee discount

Price:

DCFG Conference Attendee Discount (Mentor)

Price:

Credit Card processing fee

Price: $22.50

International Credit Card processing fee

Price: $22.50

Credit Card processing fee

Price: $22.50

International Credit Card processing fee

Price: $22.50

Checkout Option*

I will mail a check

Pay by credit card

Credit Card Address*

Credit Card Address is the same as mailing address above

Street Address Apartment or PO Box City State / Province / Region ZIP / Postal Code Country

Total

Credit Card*

Card Details

Cardholder Name

Mail check to:
Village Music Circles
108 Coalinga Way
Santa Cruz, CA 95060-6202 USA

Phone

This field is for validation purposes and should be left unchanged.