2009 UAB Music Technology Summer Camp Application Form This application may be opened as a Word document and filled out on the computer, or printed and filled out by hand. Please email, mail, or fax completed application, and make payment by the application deadline to ensure camp participation. For questions, contact Dr. Scott Phillips at (205) 975-8722 or email@example.com. June 22-26 Resident ($395) Application Deadline: May 20, 2009 Select the dates and residency June 22-26 Commuter ($275) Application Deadline: June 1, 2009 options for the camp you wish to July 13-17 Resident ($395) attend: Application Deadline: June 10, 2009 July 13-17 Commuter ($275) Application Deadline: June 22, 2009 Name: Phone: Address: City: Zip: Email: T-shirt Size: Select Size Grade in School, Fall ’09: Select Grade Parent or Legal Guardian: School Music Experience: Band (instrument: ) Choir Other: Statement of Music Technology Experience and Interest Please explain why you are interested in the UAB Music Technology Summer Camp: Special Needs The UAB Department of Music wants this camp to be accessible to all students. If special accommodations will be required, please specify here: Payment Options Payment must be received by the application deadline to ensure camp participation. Email, mail, or fax this application and Email, mail, or fax this application, and pay by mail a check or money order payable to: Visa or MasterCard by calling: UAB Department of Music (205) 934-5716 email: mail: fax: UAB Music Technology Summer Camp The UAB Department of Music firstname.lastname@example.org 205-975-1931 1530 3rd Ave South Birmingham, AL 35294-1260 The University of Alabama at Birmingham administers its educational programs and activities, including admission and employment, without regard to race, color, religion, sex, national origin or handicap. UAB also complies with the Age Discrimination in the Employment Act of 1967. Title IX of the Education Amendments of 1972 specifically prohibits discrimination on the basis of sex.
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