Mail or Fax Registration Form

FOR OFFICE USE ONLY

Fall Semester 2014

Received: ____________

If your class requires an audition, placement exam,

or interview, you cannot register by mail.

PLEASE PRINT
Mr./Ms. ____________________________________________________________
Name (Last/First/M.I.)

Phone (Day) ________________________________________________________

Address ____________________________________________________________

Phone (Eve) __________________________________________________________

City/State/Zip ________________________________________________________

Phone (Cell) __________________________________________________________

E-mail ______________________________________________________________

Social Security #__________________________ Birthdate __________________

n U.S. Citizen

n Non-U.S. Citizen ________________________________ n English Language Proficient ________________________________

Visa type

TOEFL Score

Please write the correct Course Number, Section (if applicable), Title, Instructor, and Tuition:
COURSE # and SECTION

COURSE TITLE

Mail-in registration should be postmarked

10 days before the first class
Please M A I L registration form to:
The Juilliard School Evening Division
60 Lincoln Center Plaza
New York, New York 10023
or FA X to: (646) 505-4110
CONTRIBUTIONS
The Juilliard School welcomes
tax-deductible contributions to help support
its college students and programs.
juilliard.edu/giving

INSTRUCTOR

TUITION

Less discount* (on tuition only):

($
)
________________

Please check applicable discount below

n Senior Citizen
n Juilliard Ovation Society Member
n New York Philharmonic Subscriber
Subscriber # ________________________
$30.00
Nonrefundable registration fee (not applicable for short courses): ________________
Nonrefundable library use fee (optional $35.00): ________________
Nonrefundable practice room fee (optional $75.00): ________________
(available only for advanced piano and voice classes)
Nonrefundable accompanist and/or performance lab fee (if required): ________________
Tax deductible contribution: ________________
TOTAL: $ ________________
* For discount, library, and practice room information please refer to Pages 4 & 5.

n I have read and understood the Evening Division Student Handbook and agree to abide by all policies and procedures.

METHOD OF PAYMENT

n Check/money order payable to The Juilliard School

Account # ________________________________________________________

n MasterCard

Expiration Date ____________________________________________________

n Visa

n American Express

Authorized Signature ________________________________________________