SMJ WORKSHOPS 2021 - BOSTON NO. SHORE REGISTRATION FORM

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* 1. Please share your contact info ...

Name

Address Line 1

Address Line 2

Best Phone #

Email Address:

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* 2. I would like to register for ...

SMJ - Instrumental Program

SMJ - Tap Program

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* 3. Would you like to stay at Wylie Inn & Conference Center (SMJ will submit your name to the hotel)

Yes

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* 4. If you plan to stay at Wylie, please let us know:

Check-in Date

Check-out Date

Special Request(s) if possible:

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* 5. If you are an instrumentalist, please share what instrument(s) you play:

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* 6. I prefer to pay tuition by:

Venmo

Zelle (from your bank)

PayPal (3% PayPal surcharge)

Personal Check

Not sure - please share more info on options

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* 7. I am an instrumentalist, and will register at the following tuition rate:

Standard Tuition Rate ($1125)

Contributors' Circle - Louis Armstrong Tuition Rate: $1375 (includes 1 complimentary private lesson)

Contributors' Circle - Jobim Tuition Rate: $1625 (includes 2 complimentary private lessons)

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* 8. I am a Tapper, and will register at the following tuition rate:

Standard Tuition Rate: $845

Contributors' Circle - Eleanor Powell Tuition Rate: $995 (includes 1 complimentary lesson)

Contributors' Circle - Gregory Hines Tuition Rate: $1145 (includes 2 complimentary lessons)

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* 9. If you'll be making a contribution, please answer below:

SMJ can add my name to the Contributors' Circle List

I prefer my contribution to remain anonymous

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* 10. I understand that I will need to submit documentation of Covid vaccination, and adhere to Endicott College's & Samba Meets Jazz Workshops' Covid protocols.

Yes

SMJ WORKSHOPS 2021 - BOSTON NO. SHORE REGISTRATION FORM

Question Title

* 1. Please share your contact info ...

Question Title

* 2. I would like to register for ...

Question Title

* 3. Would you like to stay at Wylie Inn & Conference Center (SMJ will submit your name to the hotel)

Question Title

* 4. If you plan to stay at Wylie, please let us know:

Question Title

* 5. If you are an instrumentalist, please share what instrument(s) you play:

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* 6. I prefer to pay tuition by:

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* 7. I am an instrumentalist, and will register at the following tuition rate:

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* 8. I am a Tapper, and will register at the following tuition rate:

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* 9. If you'll be making a contribution, please answer below:

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* 10. I understand that I will need to submit documentation of Covid vaccination, and adhere to Endicott College's & Samba Meets Jazz Workshops' Covid protocols.

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* 11. If you'd like to share any additional info, please do so below.