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Text File  |  1991-10-01  |  4KB  |  117 lines
  1.  
  2.  
  3.                                            Registration Form Page.1
  4.         
  5.         Press P to print out this form:
  6.         
  7.                               RON VAN HOOSE
  8.                        Tuner - Technician - Author
  9.                       4291 Holland Road,  Suite 534
  10.                         Virginia Beach, VA  23452          
  11.         
  12.         
  13.                          STUDENT REGISTRATION FORM
  14.         
  15.         Before  filling out this form, please read the file  STUDENT 
  16.         INFORMATION.  Request this from the main menu.
  17.         
  18.         ____________________________________________________________
  19.         PLEASE PRINT:
  20.         
  21.         NAME     ___________________________________________________
  22.         
  23.         ADDRESS  ___________________________________________________
  24.         
  25.         CITY     ________________________ STATE __________ ZIP _____
  26.         
  27.         ____________________________________________________________
  28.         The  following  personal  information is  not  required  for 
  29.         registration.  However, it may be helpful when corresponding 
  30.         with you via telephone or audio tapes.
  31.         
  32.         FORMAL EDUCATION:  High School Graduate?  Yes ___ No ___
  33.                            College Graduate?      Yes ___ No ___
  34.                            Highest year completed 1 __ 2 __ 3 __
  35.         
  36.         College Major: _____________________________________________
  37.         
  38.         WHY DO YOU WANT TO LEARN TO SERVICE PIANOS?  _______________
  39.         
  40.         ____________________________________________________________
  41.         
  42.         ____________________________________________________________
  43.         
  44.         ANY PHYSICAL PROBLEMS WITH HEARING, ARM OR BACK - OTHER?
  45.         
  46.         ____________________________________________________________
  47.         
  48.         ____________________________________________________________
  49.         
  50.         HAVE YOU STUDIED PIANO TUNING BEFORE?  Yes ___ No ___
  51.         If yes please explain:______________________________________
  52.         
  53.         ____________________________________________________________
  54.         
  55.         ANY MUSICAL TRAINING OR EXPERIENCE?    Yes ___ No ___ 
  56.         If yes please explain: _____________________________________
  57.         
  58.         ____________________________________________________________
  59.  
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  62.  
  63.  
  64.  
  65.  
  66.                                             Registration Form Page.2
  67.  
  68.         I  request  to  be registered in  the  Piano  Tuning  course 
  69.         "STRICTLY TUNING".  My check or money order is enclosed  for 
  70.         the items and/or services requested. (please no cash)
  71.                                   
  72.                                   *******
  73.         Registration, Illustrations, and Audio tapes       $ 29.95
  74.         
  75.         Business/Repair Disk  Including all diagrams          FREE
  76.        
  77.         Disk size requested 5.25" [ ]  3.5" [ ]
  78.         
  79.         Basic Tool Kit (optional $30.00)                     _____
  80.         
  81.         Authorization for Technical Support via Audio         FREE
  82.         Tapes (see submission cost in Student Infor-
  83.         mation file)
  84.         
  85.         Course Examination/Grading/Certificate               _____
  86.         (not required)  May request anytime within
  87.         five years of registration ($15.00)
  88.         
  89.         AFTER Graduation - Telephone Support for              FREE
  90.         One FULL year
  91.         
  92.         Shipping/handling:
  93.         U.S. $3.00 - Canada/Mexico $8.00
  94.                      ALL Other countries  $15.00             _____
  95.         
  96.         Total Enclosed - U.S. funds only                   $ _____
  97.         
  98.         ************************************************************
  99.         I  understand there is a shipping/handling charge  for  each 
  100.         submission of audio tapes and for the submission of the tape 
  101.         for the final examination.
  102.         
  103.         ___________________________________        _________________
  104.                  (student signature)                     (date)
  105.         
  106.         
  107.         Registered:
  108.         
  109.         ___________________________________        _________________
  110.                    Ron Van Hoose                         (date)
  111.         ============================================================
  112.         
  113.         
  114.         A signed copy of this form will be returned to you.
  115.  
  116.  
  117.