Northwest Indiana Symphony Orchestra
Education Program Registration

All fields marked with an * are required.


The SCHOOL REPRESENTATIVE is responsible for notifying the Symphony Offices in writing (email, mail or fax) of any changes to the reservation before the payment deadline. Notice of cancellation MUST be made one month before the scheduled concert or event. Cancellations made less than one month in advance will require full payment. NO REFUNDS WILL BE ISSUED FOR CANCELLATIONS MADE AFTER THE ONE MONTH PAYMENT DEADLINE

Schools are responsible for arranging their own bus transportation.

School*:
Contact*:
Position*:
School Billing Address*:

New Address?:		 Yes No
School Mailing Address:

New Address?:		 Yes No
City*:
State*:
Zip*:
County*:
School System*:
Grade Levels*:1 2 3 4 5 6 7
8 9 10 11 12
Type of School*: Public
 Private
 Home
School Phone*:
Fax:
Number of Buses*:
E-mail*:
EDUCATION CONCERTS - November 10, 2010 - STAR PLAZA THEATRE
Registration & Payment Deadline: October 13, 2010
Choose Time: 9:15 am
10:45 am
Number of students per grade:
Number of Chaperones:
Total Amount for Students ($6 ea):
Total Amount for Chaperones ($6 ea):
Number of Disabled Students:
Nature of Disability:
TOOT 'N DOODLE - NOVEMBER 4, 2010 - CVPA - MUNSTER
Registration and Payment Deadline: October 7, 2010
Choose Time: 9:30 am
12 noon
Number of Students per Grade:
Number of Chaperones:
Total Amount for Students ($6 ea):
Number of Disabled Students:
Nature of Disability:
RHYTHM 'N HUES - APRIL 13 & 14, 2011 - CVPA - MUNSTER
Registration & Payment Deadline: March 16, 2011
Choose Date: April 21, 2010
April 22, 2010
Choose Time: 9:30 am
12 noon
Number of Students per Grade:
Number of Chaperones:
Total Amount for Students ($6 ea):
Number of Disabled Students:
Nature of Disability:

I UNDERSTAND THAT IF PAYMENT IS NOT RECEIVED BY THE SYMPHONY ONE MONTH PRIOR TO THE EVENT DATE, THE SPACES I HAVE RESERVED WILL BE RELEASED TO OTHER GROUPS
Initials:
Payment: Bill Me
 Check to follow (payable to NISO)
 Credit Card (you will be contacted via phone for this information)
Verification:
Captcha