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 - October 18, 2011 - STAR PLAZA THEATRE
Registration & Payment Deadline: September 16, 2011 |
| Choose Time: | 9:25 am
10:50 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: | |
Open Dress Rehearsal for High School Students - October 20, 2011
The Auditorium at Bethel Church - Crown Point |
| Number of Students : | |
| Number of Chaperones (FREE): | |
| Total Amount for Students ($5 per): | |
TOOT 'N DOODLE - NOVEMBER 3, 2011 - CVPA - MUNSTER
Registration and Payment Deadline: October 7, 2011 |
| 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 18 & 19, 2012 - CVPA - MUNSTER
Registration & Payment Deadline: March 16, 2012 |
| Choose Date: | April 18, 2012
April 19, 2012 |
| 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: |
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