Millennium Music Conference

MMC8 CONFERENCE REGISTRATION

Register Online From Acteva

OR
to register by phone, call John Harris at 717-221-1124

OR
Fill out the form below, print it and mail to the address at the bottom of this page.

Millennium Music Conference - Individual Registration Form
(PLEASE NOTE: If registering more than one person, forms must be filled out for each person.)

INDIVIDUAL REGISTRATION
Name:
Title:
Company:
Type of Business / Band Affiliation / Student Affiliation:

Mailing Address: (include city, state/province, ZIP)

Phone:
Alt Phone:
Fax:
E-Mail:
Web Site:

Non refundable registration fee of:
Full Registration before March 15, 2004 ........$55.00
Full Registration before April 26, 2004......$75.00
Full Registration before June 10, 2004..........$95.00
After June 10, 2004 and walk up.................$125.00
Currently matriculated students and submitted musicians before June 10......................................$55.00
Currently matriculated students and submitted musicians after June 10, 2003 and walk up.................$75.00

Method of Payment (Please make checks and money orders payable to Millenium Music Conference):
Check | Money Order | Visa | Mastercard | American Express

Amount (choose one):
Full Registration before March 15, 2004 - $55.00
Full Registration before April 26, 2004 - $75.00
Full Registration before June 10, 2004 - $95.00
After June 10, 2004 and walk up - $125.00
Currently matriculated students and submitted musicians before June 10 - $55.00
Currently matriculated students and submitted musicians after June 10, 2004 and walk up - $75.00

Credit Card #:
Expiration Date:
Name as printed on Card:
Billing Address (Address, City, State Zip):

Signature:
Date:

Please return registration via fax w/credit card info to 717-221-1159, or mail with payment to:

Millenium Music Conference
PO Box 1012
Harrisburg, PA 17108-1012
717-221-1124