Great Lakes Music Festival Payment

Registration Details

Please indicate below the number and names of students who will be attending and if any will participate in the Music Scholarship competition.

Number of commuters

($45 through January 9 or $60 thereafter)

Names of commuters

Number of dorm students

($60 through January 9 or $75 thereafter)

Names of dorm students

Do you have students participating in the Music Scholarship competition? ($20)

YesNo

Competition participants

($20 - Must also register as Commuter or Dorm, above.)

Names of competition participants

Grand Total

Payment Information

Customer Details

First Name

Last Name

Organization Name

Email Address

Phone Number

Billing Address

Street

City

State

Zip

Country

NOTE: There are no transaction/convenience fees for credit card payments.

Payment Method

Credit CardeCheck (USA Only)

Credit Card Details

Name on Card

Card Number

CVV

Expiration Month (MM)

Expiration Year (YY)

NOTE: You have chosen a non-USA billing address and the eCheck payment method. Your eCheck payment will not be able to be processed from a non-USA bank account.

Bank Account Details

Account Holder Name

Bank Name

Account Type

Account Number

Routing Number

Confirm Account Number

Confirm Routing Number

Account Numbers Match?

Routing Numbers Match?

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Contact Information