Drum Circle - Dynamic Music Services, Inc.

Your Name:*

First Last

Address*

Street Address Address Line 2 City State Zip code

Email*

Phone*

Photo & Video Release*

Photos and videos may be used for promotional purposes on our website, social media, and print materials. If you do not grant permission, photos and videos of you will not be used outside of class for any reason.

Please list any special considerations

Please list anything that you need for us to know.

I will be attending the following class(es):*

All 3 Dates
September 25th
October 30th
November 20th

Register for Drum Circle*

All 3 dates - $54.00
I will be using Medicaid Waiver to pay

Register for Drum Circle*

September 25th - $18.00
I will be using Medicaid Waiver to pay

Register for Drum Circle*

October 30th - $18.00
I will be using Medicaid Waiver to pay

Register for Drum Circle*

November 20th - $18.00
I will be using Medicaid Waiver to pay

Total

$0.00

Payment Method

Drum Circle Registration