Membership Enrollment Form | Bexley Music Parents

Parent 1 Information

First Name

Last Name

Email

Phone

Address

City

State

Zip

Parent 2 Information

First Name

Last Name

Email

Phone

Address

City

State

Zip

Student 1 Information

First Name

Last Name

Graduation Year

Programs (check all that apply)

Band Jazz Choir Orchestra

School

High School Middle School Elementary School

Bexley Music Yard Sign?

Yes, include graduation year Yes, no graduation year No sign

Student 2 Information

First Name

Last Name

Graduation Year

Programs (check all that apply)

Band Jazz Choir Orchestra

School

High School Middle School Elementary School

Bexley Music Yard Sign?

Yes, include graduation year Yes, no graduation year No sign

Student 3 Information

First Name

Last Name

Graduation Year

Programs (check all that apply)

Band Jazz Choir Orchestra

School

High School Middle School Elementary School

Bexley Music Yard Sign?

Yes, include graduation year Yes, no graduation year No sign

Enrollment Options

Membership Type

Family Annual Membership - $30

Covers all members of family (within residence) for school year

Family Lifetime Membership - $150

Covers all members of family (within residence) for lifetime

Yard Signs

Your first yard sign is FREE with enrollment. Additional yard signs are $10 each.

Additional Yard Signs:
You have selected 0 yard signs ($0)

Additional Donation Amount

Any amount welcome!

$

Enrollment Total

$0

Billing & Payment Information

Card Number

Expiration

CVV

Post Code

In addition to my membership dues, I am interested in volunteering for (check all that interest you):

Merchandise Sales

Membership

Bake Sales

Fundraising

Other