WISCONSIN CONSERVATORY OF MUSIC
class registration form
Please call 414-276-5760 to register for Private Lessons.

Student Name
Student Date of Birth
Address
City, State, Zip
School
Parent/Guardian or Financially Responsible Party
Employer
Home Phone
Work Phone
Email Address

Total Tuition
* Discount
* Deferred Payment Fee
* Registration Fee $25
BALANCE DUE

Tuition is due at the time of registration, whether you fax or send your form through standard mail.
You may opt to fax your form to us if paying by credit card. Fax: 414-276-6076
If you choose to mail this form to us:
- Check/money order must be mailed along with registration form.
- If paying with Credit Card (VISA, MasterCard), all fields must be complete.
- Make checks/money orders payable to: Wisconsin Conservatory of Music

Wisconsin Conservatory of Music
Attn: Registrar
1584 N. Prospect Ave
Milwaukee, WI 53202

I will pay today with:
Credit Card: VISA or MasterCard ONLY.
Check or Money Order
Credit Card # Expiration
Amount Access Code
Access code appears on the back of your card after your card #.

* See "Policies and Procedures" before mailing or faxing this form.