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SUMMER INTENSIVE 2010
Print
this page, fill in the necessary information, and fax to:
818.752.8386 or mail to:
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MDC - Summer Intensive 2010
5113 Lankershim Blvd.
North Hollywood, CA 91601
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PART
1: CONTACT INFO PLEASE
PRINT NEATLY. THANK YOU.
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Name___________________________________________________________
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Address_________________________________________________________
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City_____________________________________State/Prov______________
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Zip/Postal_________________________Country_______________________
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Phone
________________ Cell __________________ Fax________________
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Email
__________________________________________________________
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PART
2: BILLING INFORMATION
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PLEASE
FILL OUT THE ADDRESS PORTION OF THIS SECTION IF YOUR BILLING
ADDRESS IS DIFFERENT FROM THE ADDRESS IN PART 1.
I would like to register for (choose 1)...
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[
]
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1
week
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$575
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[
]
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2
weeks
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$1000
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[
]
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3
weeks
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$1375
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| [
] |
4
weeks |
$1700 |
[ ] |
5
weeks |
$2175 |
| [
] |
6
weeks |
$2380 |
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___DORMS ___ NO DORMS
Select date(s)
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] |
6/21-6/27 |
[
] |
6/28-7/04 |
[ ] |
7/05-7/11 |
[ ] |
7/12-7/18 |
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] |
7/19-7/25 |
[
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7/26-8/01 |
No
Refunds! Credit Only.
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Name___________________________________________________________
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Company________________________________________________________
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Address_________________________________________________________
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City_____________________________________State/Prov______________
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Zip/Postal_________________________Country_______________________
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Credit
Card Type: [ ] American
Express,
[ ] Eurocard/Mastercard,
[ ] Visa
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Credit
Card Number______________________________________
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Credit
Card Expiration______________________ CVC Code __________
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PLEASE READ: Thank You for registering for The Summer Intensive 2010.
Please fax or mail this form to the number/address above. If you
have any questions about this registration, please call Jin at
818-753-5081
during business hours. Please DO NOT send money with this form. Millennium
is not responsible for delayed/lost mail, mechanical failures of the
Postal Service, and/or electronic failures of fax transmissions.
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