MODE MUSIC STUDIOS STUDENT SPONSORSHIP REGISTRATION

Mode Music Studios
3805 Delridge Way SW

Seattle WA 98106
http://www.modemusicstudios.com

Thank you for expressing interest in sponsoring one of our students in private music lessons. We greatly appreciate your support! All information expressed in this form will be kept confidential and shared only among administrative staff in registering a new student who has applied for financial assistance.

SPONSOR INFORMATION

SPONSOR 1 FIRST NAME *

LAST NAME *

Gender *

Birth Date * +

SPONSOR 2 FIRST NAME

FIRST NAME

Gender

Birth Date +

Street Address *

City *

State *

Zip Code *

Cell Phone Number *

Email Address *

SPONSORSHIP SELECTION

Please select a sponsorship level below. This will be a recurring charge each month, and can be cancelled with 30 days notice. 30-minute private lessons are $33 each, and you will also have the option to round up your donation to Mode Music and Performing Arts to help us with our other endeavors.

MONTHLY SPONSORSHIP LEVEL *

1 lesson per month ($33)

1 lesson per month + donation ($40)

2 lessons per month ($66)

2 lessons per month + donation ($70)

1 month of lessons ($132)

1 month of lessons + donation ($140)

Donations will be set to recur monthly until our staff is notified within 30 days of termination of sponsorship. If you know the date you wish to end your sponsorship commitment, please indicate below. +

Would you like to receive monthly updates from the teacher regarding your sponsored student's progress? *

Do you have a student in mind to sponsor? If so, please give the student's first and last name here.

STUDENT SPONSORSHIP AGREEMENT

SPONSORSHIP COMMITMENT

As a sponsor of a student at Mode Music Studios, you are commiting to financially assisting a family who has applied for private lessons through our studio. Termination of this commitment requires notifying Mode Music Studio staff 30 days prior to the final charge. This time will allow our staff to locate another sponsor for the family without inhibiting the student's time with their instructor.

I, the undersigned, hereby commit to recurring charges each month for the above selected amount. I will give Mode staff 30 days notice of my intent to discontinue sponsorship of the student.

INITIAL BELOW *

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AGREEEMENT

Completion of this form will automatically subscribe you to our Mode Music Studios newsletter. This is a monthly publication that includes information on upcoming events, private lesson deals, and upcoming MMPA enrichment sessions. You can opt out at any time.

Sponsor Name *

+-

Today's Date * +

By signing below, I acknowledge that I have read and understand the terms and conditions of this contract. *

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