Private Music Registration (PMI)

Welcome to NEMPAC’s Private Music Registration. Please fill out the below form. We are working on getting our Credit Card payment up and running online, however for now, please send any payments via check to Sherri Snow, Coordinator, or contact her directly for Credit Card payments at ssnow@nempacboston.org. Call the NEMPAC office at 617-227-2270 for information.

Last Name
First Name
Address
City
State
Zip Code
Email
Phone Number
Grade (if applicable)
School Name
Instrument(s)
Instructor
Lesson Day/Time
Lesson Length (minutes)
Lesson fee (example –$30/30 min, $40/45 min, $50/60 min): $
Scholarship Reduction (if applicable – scholarships reduce the cost of each lesson by $15): $
Total cost of each lesson x 10 lessons = $
Late fee charge $25 (If submitted afterJan 9): $
Release
Datestamp (enter as dd/mm/yyyy):