FEES
Early Bird Registration $75 (before June
1, 2009)
Late Registration (after June 1, 2009) $
90
Note: Members of the Academy of Indian Music,
South Plainfield, NJ can avail of 10% discount
REGISTRATION FORM
All Fields Required. Please Print Clearly
Full Name
:________________________________________________________________________
First
Middle Initial
Last
Mailing Address
:________________________________________________________________________
Street
City
State
Zip Code
Daytime Phone
:(____)________________________________________
Fax Number
:(____)________________________________________
E-Mail Address
:______________________________________________
Educational Background
:______________________________________________
Musical Interest, background and experience
(please describe)
:______________________________________________
Payment Information
If paying by check, please make payable
to Audiopedics, LLC and mail the registration
form to: AUDIOPEDICS, LLC 13 Melanie Lane,
Phillipsburg, NJ 08865. You may fax the
registration to (908)-454-4482. If paying
by credit card, please call Shaila
at (908)-479-1341 or Akila at (646)270-1296.
CREDIT CARD INFORMATION:
NAME OF THE CARD HOLDER:
NUMBER:
EXPIRATION DATE:
CVC number at the back of your card:
TYPE (visa/MC/AMER-EXP):
