Great Lakes Music Festival Payment

Registration Details

If you are paying for multiple registrants, please fill out the form separately for each type of situation (e.g., some piano competition participants and some not).

Number of Registrants

Names of Registrants

Participating in Piano Competition ($30)

YesNo

Accommodations

Staying in Dorm ($50 through January 8 or $65 after)Commuting ($35 through January 8 or $50 after)Only Participating in Piano Competition

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

Expiration Year

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