Please Print this page, fill out, and return to email or address provided in the form registration below.

Raise a Ruckus Summer 2019 - Please print clearly.

First Name Last Name

Parent’s Name

Mailing Address

APT # or BOX #

City

State

Zip

School

Grade

Instrument

Violin Cello Guitar Mandolin

Parent’s Cell

Receive text msgs YES NO

Parent’s E-mail

Student’s Cell

Receive text msgs YES / NO

Student’s Email:

CIRCLE SESSION CHOICE

Session 1 (June 9th-13th)—$125 Session 2 (June 23- 27th)—$125

Session 1 and 2 COMBO ($225)

SESSION TIMES

5:00-6:30pm (Beginner/Intermediate) / 6:30-8:00pm (Intermediate/Advanced)

PARENT/PARTICIPANT (Please print)

SIGNATURE

DATE

COMPLETED REGISTRATION FORMS MAY BE RETURNED BY ANY OF THE FOLLOWING METHODS:

1. EMAIL TO: raisearuckuslagrange@gmail.com

2. MAILED to the LSO office at: P.O. Box 2321 LaGrange, GA 30241

3. DELIVERED in person to the the LSO office on the 2nd floor of Suntrust Bank at 301 Church St., LaGrange, GA 30240

FULL SESSION PAYMENT SHOULD BE SUBMITTED WITH REGISTRATION BY EITHER:

1. MAILED to the LSO office at the P.O. Box address listed above.
2. PAYPAL: The LSO can be found at info@lagrangesymphony.org on PayPal
3. DELIVERED in person to the the LSO office on the 2nd floor of Suntrust Bank at 301 Church St., LaGrange, GA 30240