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| Performing Arts Program 2008 ~ Registration Form Registration may be either faxed (732-842-9323), dropped off at The Count Basie Theatre Box Office, or returned by mail to: Count Basie Theatre, 99 Monmouth Street, Red Bank, NJ 07701 Name _________________________________________ Age ____ Gender m ___ f ___ Address __________________________________________________________ City _______________________ State__________ Zip ________________ Phone _____________________________ Email ___________________________________________ #1 Course Name _______________________________________ Start Date_________ Time____ AM/PM #2 Course Name _______________________________________ Start Date_________ Time____ AM/PM #3 Course Name _______________________________________ Start Date_________ Time____ AM/PM If under 18, parents signature required _____________________________________________ Non Re--fundable registration fee: $10.00 per person (please include in payment) Fees Enclosed _________ Type of payment: Check___ Credit Card___ Visa ___Mastercard ___ American Express ___ Credit Card # ____________________________________ Expiration date _________ Sec.No.___ Signature ________________________________ Print name ____________________________ Please note there will be no refunds given after start date of class. Make check payable to: THE COUNT BASIE THEATRE Refund Policy: If a student withdraws or cancels registration the following will apply: Course cost will be granted up to 3 weeks prior to the start of class. Refunds minus 10% is granted up to 2 weeks prior to the start of class. Refund minus 25% is granted up to one week prior to start of class. Refund minus 50% is granted if less than 7 days prior to start of class. NO REFUNDS after start of class. Pro-rated refunds will be given at any time during the session for medical emergencies when accompanied by documentation. |
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