Registration Form

If you have questions or would like to request a paper copy of the registration form, you may call(315) 267-2167 or e-mail cym@potsdam.edu.

A non-refundable $50 deposit is due with this form. Balance of payment is due May 31, 2013.

* - Denotes required fields

Student's Name*: A value is required.Minimum number of characters not met.
School:
Parent's Name*: A value is required.Minimum number of characters not met.
Address*: A value is required.Minimum number of characters not met.
City*: A value is required.Minimum number of characters not met. State*: Please select an item. Postal Code*: A value is required.Minimum number of characters not met.
Work Phone:
Home Phone*: A value is required.Minimum number of characters not met.
Cell Phone:
E-mail address:

Resident $975     Commuter $670 (includes daily lunch)

Gender*:


Please make a selection.

DOB:


Grade: (Fall 2013)


T-shirt size*:





Please make a selection.

Please choose only one track:
 1. Instrumental / Specify Type:
 2. Piano
 3. Voice (Please select a range)
      Soprano 
      Alto 
      Tenor 
      Bass

Roommate request:


How did you learn about CYM?


Payment Information

Please charge my credit card only the non-refundable $50 deposit at this time. $
Please charge my credit card the full payment now. $
Please charge my credit card only this amount at this time: $


Have a question or comment?

Center for Lifelong Education and Recreation
389 Van Housen Ext., SUNY Potsdam
44 Pierrepont Ave., Potsdam, New York 13676
phone: (315) 267-2167 fax: (315) 267-3350
e-mail: cym@potsdam.edu

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