Choir Chime & Hand Bell Summer Program

Monday-Friday 9:00 - 12:00 (noon)

August 22-26, 2005

Registration

Name:

Address:

City: Zip:

Phone Number:

Grade Level (completed by 6/05):

o 1^st o 2^nd o 3^rd o 4^th o 5^th o 6^th o 7^th o 8^th o 9^th o10^th o 11^th o 12^th o Adult

T-shirt Size:

Youth: o M; o L;

Adult: o S; o M; o L; o XL; o XXL o Other:

Music Experience (if any):

Existing Medical and / or Dietary Restrictions we should know about:

For Minors: Registration must be signed by a Parent and / or Guardian:

Name Signature Phone

$10.00 Registration Fee payable to: Island Presbyterian Church

Mail Registration to:

Attn: Girl Scout Troop #1023

1822 Huth Road

Grand Island, NY 14072

Registration Open: June 1 – August 5, 2005