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									                   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 slpmusic@uab.edu.
                                                   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
slpmusic@uab.edu                                                                                        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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