2017 WOODY HERMAN JAZZ FESTIVAL REGISTRATION FORM

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Send completed forms and money to: 2419 E. Kenwood Blvd, Milwaukee, WI 53211

and mark on the envelope: Attn: Zelazo Box Office GENERAL INFORMATION Name: _____________________________________________________________ School: ____________________________________________________________ School Address: _____________________________________________________ City: __________________________ State: _______ Zip: ____________________ Phone: __________________________ Email: ____________________________ SELECT YOUR SESSION DATE AND TIME PREFERENCE Friday Sessions (March 10th, 2017)

Friday Morning (8:30 AM - 1:00 PM) Friday Afternoon (11:00 AM - 3:30 PM)

ENSEMBLE & TRAVEL INFORMATION Number of Students: ________ Number of Chaperones: _______ Number of Truck/Bus/Van Drivers: ________ Number of Graduating Soloists to be featured (High Schools Only): _______ Do you have a student in our UWM Youth Jazz Ensemble (circle one): YES NO

2017 WOODY HERMAN JAZZ FESTIVAL REGISTRATION FORM

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PAYMENT INFORMATION TYPE OF GROUP # OF GROUPS PRE-TOTAL Middle School Jazz Combo: ______ x $195.00 = $________ Middle School Jazz Ensemble: ______ x $195.00 = $________ High School Jazz Combo: ______ x $250.00 = $________ High School Jazz Ensemble: ______ x $250.00 = $________ University Jazz Combo: ______ x $295.00 = $________ University Jazz Ensemble: ______ x $295.00 = $________ Youth Jazz Ensemble Discount: -$50.00 = -$________ Non-Refundable Service Charge: $4.00 TOTAL: $_________ Payment Method

Check enclosed (payable to UWM Music Dept: Jazz Studies)

Credit Card (circle one): VISA Mastercard Account #:

____________________________________________________

Signature (for credit card holders): _________________________________

Name of Credit Card holder: ______________________________________

Send completed forms and money to: 2419 E. Kenwood Blvd, Milwaukee, WI 53211 and mark on the envelope: Attn: Zelazo Box Office