Name_________________________________________________ Date of Birth ________________________ Address___________________________________ City___________________ State ______ Zip_________ Email ____________________________________________________ Cell ____________________________

Additional Email Address (optional) ________________________________ ☐Male ☐ Female ☐Other

Please specify any special needs or limitations of participant: ___________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ How did you hear about Mason Community Arts Academy and this program? □ I’m a returning student □ Print Publication □ Email Newsletter □ Internet Search □ Conference □ Digital/Online Ad □ Professional Organization (OAKE, AOSA) □ Summer Catalog in Mail □ Professional or Friend Referral

Certification Levels Courses, July 13 - 24, 2020 In-State Tuition Out-of-State Tuition

Orff Levels (3 credits each) COURSE # □ Orff Level I (8:30am - 4:30pm) MUSI 563 607 □ $1,698 □ $2,019 □ Orff Level II (8:30am - 4:30pm) MUSI 564 608 □ $1,698 □ $2,019 □ Orff Level III (8:30am - 4:30pm) MUSI 565 609 □ $1,698 □ $2,019 Kodaly Levels (3 credits each)

□ Kodaly Level I (8:15am - 4:35pm) MUSI 557 604 □ $1,698 □ $2,019 □ Kodaly Level II (8:15am - 4:35pm) MUSI 558 605 □ $1,698 □ $2,019 □ Kodaly Level III (8:15am - 4:35pm) MUSI 559 606 □ $1,698 □ $2,019 Supplemental Courses, July 6 - 10, 2020 □ Master Class (3 credits) 9 am - 4:30 pm MUSI 592 614 □ $1,698 □ $2,019 □ Creative Movement (1 credit) 9 am -11:30 am MUSI 592 613 □ $ 566 □ $ 673 □ Choral Music in Class (1 credit) 9 am - 11:30 am MUSI 592 612 □ $ 566 □ $ 673 □ Alexander Technique (1 credit) 9 am - 11:30 am MUSI 592 610 □ $ 566 □ $ 673 □ Brush Up Kodaly (2 credits) 12 pm - 4:30 pm MUSI 592 611 □ $1,132 □ $1,346 □ Technology in Class (2 credits) 12 pm - 4:30 pm MUSI 592 615 □ $1,132 □ $1,346

Please complete registration form on page 2

Programs (check program and tuition boxes to register)

Registration Form

Orff & Kodály Courses Summer 2020

FOR GMU GRADUATE CREDIT

Note: We reserve the right to cancel or postpone any program or activity due to inclement weather or low enrollment. A service fee will be imposed for all returned checks and could result in refusal of future participation. All tuition costs include a $50 non-refundable cancelation fee, except when classes are cancelled by Mason Community Ar ts Academy. Participant Waiver: In consideration of my, and/or my childs, par ticipation in this activity I hereby release and discharge the Organiztion, and its representatives, successors and assignors, from any and all liability arising from accident, injury and illness that I (he/she) may suffer as a result of my (our) participation in this activity. I (we) also will follow the rules and regulations set out by the Organization and above named parties. Parent or guardian must sign for anyone age 18 and under. I do hereby grant and give these groups the right to use my and my child(s) photograph, image or video both singly and in conjunction with other persons or objects and presentations, advertising, publicity, and promotion relating thereto. Signature _____________________________________________________________ Date __________________________

Please mail (make checks out to “George Mason University” or provide credit card info) or FAX (credit card info only) this form and payment to:

Mason Community Arts Academy 4260 Chain Bridge Rd

Fairfax, VA 22030

Secure FAX: 703-359-1209

Call 703-993-9889 if you have any questions. www.MasonAcademy.org

NOTE: You will receive a Non-Monetary Receipt and a Notification from GMU Mason Community Arts Academy in your Email inbox after we process your registration.

Call 703-993-9889 if you have any questions.

Please note that you are only paying for tuition with this form. Please refer to the website for other required and optional fees, including textbooks and class materials.

Payment Options: Please make checks payable to George Mason University □ Pay in full with check □ Pay in full with credit card

Total for program(s) $__________________ Total Amount Enclosed $__________________ Credit Card Number ______________________________________Expiration Date ____________________ Name on Card ____________________________________________________________________________ Type of Credit Card (Visa or MasterCard only) __________________________________________________ Signature for payment ______________________________________ Security/ CVV Code____________

REQUIRED: COMPLETE CREDIT CARD BILLING ADDRESS (Your registration will not be processed without this)

Address __________________________________________________________________________________

City _______________________________ State ___________ Zip _________________________________

PARKING & HOUSING INFORMATION

If you plan on parking a vehicle on the GMU campus during program hours, you are required to have a GMU weekly parking pass. Passes - which are good for Lot K on campus - are available for $25 per week. Parking pass is not necessary for

drop off/pick up of students. Visitors may also choose to park in the Mason Pond Parking Deck for $3/hour or $14 per day.

TO PURCHASE A PASS GO TO: https://masonacademy.gmu.edu/about-us/parking/

HOUSING: Economically-priced dorm-style, on-campus housing may be available. For details and payment, go to:

https://masonacademy.gmu.edu/teacher-training/housing-orff-kodaly/