PAYMENT FORM for PRIVATE LESSONS

P.O. Box 1325, 245 E. High Street Pottstown, PA 19464 610.970.1199; www.steelriver.org

PAYMENT FORM for PRIVATE LESSONS 2017/18 School Year FORM D - Must be attached to appropriate registration form(s)

Student Name: ______

TUITION CALCULATION AND PAYMENT WORKSHEET

Annual Registration Fee: $______($20/year per student for private lesson students covers private lesson & camp instruction from July 1-June 30)

(If you paid this for a 2017/18 camp registration earlier in the year, you do not need to pay it again for private lessons) ------PRIVATE LESSONS

See the private lesson pricing information in the Info Sheet for your exact fee. Drop in rates for 2017/18 school year are:

How long do you want your lesson to be? 30 minutes 45 minutes 60 minutes (circle one)

Which Instructor are you meeting with? ______

Have you scheduled your lesson time? If so, please write your time and day of the week here: ______

Calculate your rate:

I am signing up for a semester session (11 lessons and the recital or 12 lessons) and my rate (based on the 2018 information sheet) is: ______

I would prefer to take ______single lessons at $______per lesson.

I AM A VOCALIST WHO WOULD LIKE TO PERFORM IN THE RECITAL:

Vocal Recital Fee: $______$10/semester to pay recital pianist.

I am a vocal student but will not be performing in recitals

Total Private Lesson(s) Payment Due: $______------GROUP CLASSES/WORKSHOPS Use the Group Class form to calculate your payment for Group Classes – no registration fee is required for taking group classes.

Total Group Classes/Workshop Payment Due: $______

------Annual Fund Donation: $______(Optional. Thank you for supporting the Steel River Playhouse)

Deductions: - $______(Have a gift certificate, include this amount here and attach your certificate to the back of your form

TOTAL AMOUNT DUE $______(Add together all amounts above)

PAYMENT METHOD:

CHECK PAYMENT (Please make check payable to “Steel River Playhouse”)

Check Number: ______Amount: $______

 CREDIT CARD PAYMENT: (If paying by credit card, please complete information on attached sheet OR visit our webpage at www.steelriver.org and use the donation button to pay online. Email [email protected] to notify her that your payment has been made)

OR USE THIS FORM

Student Name:______

Payment Description:______

Paying in One Installment Amount: $ ______OR Add $10 if paying 3 monthly installments $______

CREDIT CARD TYPE: ___VISA ___MASTERCARD ___DISCOVER ___AMEX

Name on Card (if different than above): ______

Card #: ______

V-Code______Exp. Date: ______/______

Billing Address (including zip):______(REQUIRED when “keying” the card in instead of swiping)

Phone Number to call if any questions about this charge: ______

Email if you would like a receipt:______

When paying with credit card, you may pay full amount due in three monthly installments. There is a $10 Convenience fee for this service.