Student Registration Form

D-Parental Consent Form for Student Registration

www.Samzschoolofrock.com

 ___    I cannot sponsor the program at this time but please find enclosed my contribution to a successful year.

Sponsorship Dollar Amount Enclosed:  $150 ____  $250  ____  $500 _____ Other Amt. $ ____
Please contact me about other forms of donations, musical instruments, sheet music, etc. All donations are greatly appreciated.  It takes very little to have a dramatic impact on the life of a child.  You will receive a receipt for the value of any donated items.

 Sponsor Recognition Information:

 Sponsor name as you wish it to appear on all promotional materials:

___________________________________________________________________

Sponsor Contact Name: ___________________________________________________

Address: _____________________________________________________________

City: _____________________________  State: ____________  Zip: ______________

Phone: _______________________        Email: ________________________________

Method of Payment:
____   Check enclosed – Check payable to Samz School of Music
____   Please invoice me at the above address
_____ Please charge my credit card  _____ Visa  _____MC  ____Disc  _______AMEX

Card # ______________________________________________  Expiration:____________  3 Digit Code:________

Please send your contribution and a current Company Logo for promotional purposes to:  Samz School of Music, 1111 North Main Street, Suite G, Salinas, CA 93906 or email to: Samzschoolofrock@yahoo.com. 
Questions?  Please call Sam at (831) 235-9589.  All contributions are tax deductible.  Samz School of Music is a 501(c)(3)  non-profit corporation #26-4518181.  On behalf of our students and staff, thank you for your contribution.