Registration – Village Music Circles

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
*$40 processing fee
♦ additional fees apply, we will contact you to complete processing.
License Type*
CMT Number*
Payment
Tampa Bay FAC Early Registration Discount (by December 1, 2019)
- Check here to apply discount if you are registering before December 1, 2019
San Antonio Early Registration Discount (by January 15, 2020)
- Check here to apply discount if you are registering before Jan. 15 2020
Payment Options*
- Pay $100 Deposit
- Pay Full Amount
If choosing deposit option, discount will be applied to remaining balance.
FAC Deposit
Price: $100.00
Basic FAC Tampa Bay - Jan 24-26, 2020
Price: $400.00
San Antonio RAP March 27-29, 2020
Price: $400.00
CEU Processing Fee
Price: $40.00
Early Registration for Tampa Bay Bay FAC
Price: -$50.00
Early Registration for San Antonio RAP
Price: -$50.00
Total
$0.00
Total charged today
$0.00
Checkout Option*
- I will mail a check
- Pay by credit card
- Pay with PayPal
Credit Card Address*
Credit Card Address is the same as mailing address above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Click Submit and you will be forwarded to PayPal.com to complete payment. Please be patient, it may take a few seconds for PayPal to open.
Mail check to:
Village Music Circles
108 Coalinga Way
Santa Cruz, CA 95060-6202 USA
Email
This field is for validation purposes and should be left unchanged.

Your Information

Educational Credits

Payment