Summer Studies for Music Professionals

Level 1 Registration Form & Certification Application

Print, fill-out, and submit this form to your instructor on the last day of a course, or by mail after the completion of a course.
For best results, set your page reduction to 70% or less in "page setup" to print this all on one page.

PART I: Student Information

Name_________________________________________________________________________

Address_______________________________________________________________________

City_______________________ State____ Zip_________ Phone_______________

Email (please print very clearly) _____________________________________________________

School Name or Professional Affiliation __________________________________________________

PART II: Course Transcript

It is recommended, but not required, that the courses be taken in 1A-1B sequence.

Course 1A - Basic Skills in Music Technology: Electronic Instruments; MIDI Sequencing & Notation

Site_____________________________________________________________Date____________

Instructor____________________ Instructor Signature_____________________Date____________

Course 1B - Basic Skills in Music Technology: Instructional Software; Communications & Digital Media

Site_____________________________________________________________Date____________

Instructor____________________ Instructor Signature_____________________Date____________

Part III: Fees

Please check one item from each section and write the amount on the line to the right.

Section A - Certification Fee

	This is my first TI:ME Course. (No Fee: $0)	_______
	This is my second TI:ME Course. (Certification Fee: $35)	_______

Section B - Membership Fee
TI:ME Membership is Required for Certification

	I am currently a TI:ME Member. (Membership Already Paid: $0 due)	_______
	I have been a TI:ME Member and need to renew. (Annual Membership: $40)	_______
	I am currently enrolled in a TI:ME Course and I have never been a TI:ME member. I would like the 3 month free membership and want to become a member. (Free & Annual Membership: $40 for 15 months)	_______
	I was enrolled in a TI:ME Course in 2005 and I have never been a TI:ME member. I would like just the 1 month trial membership. (Trial Membership: $0 due)	_______
	I was not enrolled in a TI:ME Course in 2004. I have never been a member of TI:ME and want to join. (Annual Membership: $40)	_______

Send this form with your check to:
TI:ME, 3300 Washtenaw Ave., Ste 220 Ann Arbor MI 48104