YOUNG AT HEART CHORALE
REGISTRATION FORM

Print this form and mail it to

Bach Festival Society of Winter Park

1000 Holt Avenue - 2763

Winter Park, FL 32789-4499

or fax it to

407-646-2692

Name _______________________________________________________

Street Address _____________________________________________

City ________________________________ State _________ Zip _____________

Phone ___________________________ Cell #__________________

(Circle one) Male     Female

COURSE TITLE	TUITION
Young at Heart Chorale	$50.00

Method of payment: Check # ___________ Cash   Visa   MasterCard

I authorize Bach Festival Society of Winter Park to charge account

# ______________________________________________

V-Code: _____________ (A 3-digit, non-embossed number found on the card signature line panel after the credit card number or near the embossed number on the front.)

with the expiration date of __________________ the total of $___________ for the above registration.

Please print name exactly as it appears on card:

______________________________________________________________________

Signature of cardholder _________________________________________________

Today's date: ________________________________

Form last revised September 1, 2007.