Name* First Last Age*GenderFemaleMaleAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Have you ever attended KoSA before?*YesNoWhich year(s) did you attend KoSA?*Major Area of Interest*Skill level for Major Area of InterestElementary (one or two years of study)Intermediate (junior high school or early high school)Advanced (high school, early college)Professional (late college, professional player)Secondary Area of InterestSkill level for Secondary Area of InterestElementary (one or two years of study)Intermediate (junior high school or early high school)Advanced (high school, early college)Professional (late college, professional player)Are You a Drum Instructor?*YesNoCost calculationsPlease answer the following questions and calculate your own total based on your answers. Then make your 50% payment securely below.Program Cost*This price includes all hands-on workshop classes, jam sessions, and final concert.$625 USD TuitionUniversity CreditDID YOU KNOW? KoSA offers University Credit just by attending our program! You can register for either undergraduate or graduate credits! YES, I want University Credit ($220 USD per credit, up to 3 credits) Number of credits123Are you part of the KoSA Family? (A past KoSA participant) Yes, I am a past KoSA participant ($50 discount) Are you a Music and Drum Instructors bringing a group of 10 or more? Yes, I am a Music and Drum Instructors bringing a group of 10 or more (FREE tuition) PAYMENT AMOUNT (50% deposit or full)*A 50% non-refundable deposit must be given to reserve your place in the program. Space is limited! All final payments are due by June 9, 2017. You can also choose to pay the full amount right now. Payment currency (must be USD)*USDIf you prefer to pay CAD, please go back and complete the CAD form.Payment total $ 0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name PLEASE NOTE: KoSA Communications requires non-residents of Quebec to have active medical coverage. PLEASE NOTE: The program officially begins on Monday June 26th at 7 p.m and finishes Saturday July 1st by 5 p.m
