<p> Jim Thomson School of Piping & Drumming Summer School Registration Form Friday, July 7, 2017 – Friday, July 14, 2017 </p><p>Student Information Name: Telephone Number: </p><p>Address: E-mail Address: </p><p>Age (If under 18): ☐ Male ☐ Female City: ☐ Parking Permit Request $20.00</p><p>State: Emergency Contact Name / Relationship:</p><p>Postal Code: Emergency Contact Phone:</p><p>Eligible For Band Discount? Name Of Band: Minimum of 4 band members. Upon first day of school, if there are not 4 band members in attendance, you will not be eligible for this discount and will be charged the discount amount if already taken. ☐ Yes ☐ No ☐ Not Sure</p><p>Registration Type (Check all that apply) Register Register before after May 15, May 15, 2017 2017 ☐ Full Room and Board (Double Occupancy) $760.00 USD $790.00 USD ☐ Single Occupancy (Additional Cost) $100.00 USD $100.00 USD ☐ Day Student Lunch & Dinner Pass (Additional Cost) $115.00 USD $115.00 USD ☐ Day Student $530.00 USD $560.00 USD ☐ NAUParking ($20.00) $20.00 USD $20.00 USD ☐ Additional T-shirts ($15.00 each) * $20.00 USD $20.00 USD ☐ Band Discount -$20.00 USD -$20.00 USD Total: Tuition Types T-Shirt Size * Quantity Payment Information ☐ Piping Light Music ☐Small ☐ PayPal ** ☐ Piping Piobaireachd ☐ Medium ☐ Visa ☐ Bass Drum ☐ Large ☐ Master Card ☐ Tenor Drum ☐ X-Large ☐ Check ☐ Snare Drum ☐ XX-Large ☐ XXX-Large Total Quantity: Total Cost: Amount Enclosed (Minimum $100 USD non-refundable): Credit Card Number: Expiration Date: Authorized Signature:</p><p>Please make checks payable to NACHS, and mail form and check to: NACHS, P.O. Box 187, Flagstaff, AZ 86002 * One T-shirt is included with your tuition. Additional T-shirts may be purchased for $15.00 each. ** To make a payment through PayPal, go to www.PayPal.com and make a payment to [email protected]</p><p>Comments:</p><p>For United States School Of Piping Use Only Date Application Received Amount Of Deposit Received Band Discount Total Money Received Number Of Additional T-shirts</p>