Mulberry Bush Mail Order Order Form

MAIL IN REGISTRATION FORM - WINTER SESSION 2013

(For mail order registration, please fill out this form and mail it to the address below.)

MOVERS AND SHAKERS: Ages newborn through four years, with parent or caretaker.
Each 6 week session is $100.00. Each sibling is $60.00. (Siblings 0-1 year are free)

"Sign Up With A Friend" Discount - Click Here!

Mulberry Bush Music on Mercer Island!
MOVERS AND SHAKERS
April 23 - May 28
Tuesdays: 10:30 - 11:15
Community Center at Mercer View
Registration Now Open - Click Here!*
*Click on "PreSchool" then "Music" in new window

Wednesdays, 10:30 - 11:15 am
April 24 - May 29
Mt. Baker Community Club
2811 Mount Rainier Drive South

6 week session

6 Class Session: Fee $100
6 Class Session: Sibling Fee $60

Fridays, 10:30 - 11:15 am
April 26 - May 31

University Heights Center
5031 University Way NE

6 week session

6 Class Session: Fee $100
6 Class Session: Sibling Fee $60

If you would like to add a copy of Hilary's award-winning release
."Cantilena: Night Songs from Around the World," at a special
.."student discount" price of $13, including shipping,
..please check this box.

One Copy of "Cantilena" (~~$16~~ $13 inc. shipping)

If you would like to add a copy of Hilary's award-winning release
."Siente: Night Songs from Around the World," at a special
.."student discount" price of $13, including shipping,
..please check this box.

One Copy of "Siente" (~~$16~~ $13 inc. shipping)

Registration and Credit Card Information

Child's Name:

(Sibling Name)

Child's Birthday:

(Sibling Birthday)

... ...

... ...

Parent's First Name:

Last Name:

Address:

City:

State:

Zip:

Daytime Phone:

Email Address:

"Sign Up With A Friend"*

........((Optional. See "Sign Up With A Friend" Page for details!)

Credit Card Number:

........((Visa/Mastercard Only)

Expiration Date:

.....

Security Code:

........................................................ What's the Security Code?

If you would like to register online, using a credit card or PayPal,
please visit our Web Order Registration Page.

To register by mail, please fill in all the information above,
print out the form, and sent it, along with a check or money order, to:

Mulberry Bush Music and Movement
9102 17th Avenue NE
Seattle, WA 98115-3212

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For More Information

Feel free to contact us at:

Mulberry Bush Music
9102 - 17th Avenue NE
Seattle, WA 98115-3212

Phone/Fax: (206) 686-2201
Email: Please use our CONTACT form.