UE Music Community Conservatory Membership Registration Form

By submitting my payment, I understand that I am joining Community Conservatory Membership in order to take private lessons or to take Community classes at the member rate. I understand that all lesson fees will be paid directly to the instructor.

* Indicates a required field

Student Information

* I am a returning private lesson student from 2022-2023

* Prefix

* First Name

* Last Name

* Birthdate

* Phone

* Email

* Mailing Address

* City

* State

Zip

Emergency Contact Information

* Contact Name

* Contact Phone

* Contact Relation

Registration Information

Note: You must have already contacted the instructor to confirm a studio opening and acceptance by the instructor.

* I have already contacted the teacher and received permission to take private lessons

* Registration Type

* Teacher

* Instrument

* T-Shirt Size

Billing Information

* Card Number

We accept VISA, Mastercard, American Express, and Discover

* Card Expiration Date

Month Year

* Card Security Code

* Name On Card

* Billing Street Address

* Billing Address City

* Billing Address State

* Billing Address ZIP

* Billing Email Address

* Billing Phone Number

Payment Agreement

You authorize the University of Evansville to initiate a charge to the above specified credit or check card. Your credit or check card statement will reference "U OF E BUSINESS OFF" as the payee. You affirm that:

I have read, understand and agree to be bound to the terms of this agreement;
I am authorized to perform transactions using the card information above;
I accept the terms of this agreement and certify, under penalty of law, that the information provided above is correct.

Should this transaction fail for any reason (including invalid account numbers, chargeback etc.) you understand that additional penalties, fees and interest may accrue.

Click the submit button only once to avoid duplicate charges. Please check your email for confirmation that your payment was submitted successfully.