Enrollment forms

"School Without Walls"
Enrollment Form

I wish to order the School Without Walls One Shot Video Series.

I have indicated the Lessons I am interested in receiving Below:

One Shot Video Series

"The Secrets of Great Improvisation"

$59.00 Complete

_{"The Art of Pro Arranging"}

$59.00 Complete

"Trading 4's" Guitar Practice

$59.00 Complete

One Shot Video Specials

Any TWO One Shot Videos

$110.00 Complete

Please Select 2 from the list

The Secrets of Great Improvisation
The Art of Pro Arranging
Trading 4's - Guitar Practice

All Three One Shot Videos:

$160.00 Dollars Complete

Dana Rasch "The Fuse" Jazz / Fusion CD & Begining Guitar Book

"The Fuse" Cassette

$7.00 Dollars Complete

"The Fuse" Compact Disc

$15.95 Dollars Complete

Dana Rash's "Begining Guitar"

$20.00 Dollars Complete

Big Band Compact Disc - 'Big, Bad, & Beautiful"

Big Bad & Beautiful Compact Disc

$15.95 Dollars Complete

Live & Well Compact Disc

$15.95 Dollars Complete

Please Complete the information Below

_{* I include payment in full.}
_{* All foreign students please pay in US Currency}

Below you will find the shipping and handling price schedules, be sure to use the schedule below to insert the correct shipping and handling price for your selected course in the space provided. "Other" on the schedule pertains to all countries other than the United States and Canada. A red "C" on the schedule means you must contact us by e-mail or phone for shipping and handling
prices for your area or region. dana@beyondchops.com (541) 552-9605

Course	One Package			All Three			Any two
Your location	U.S.	CAN.	Other	U.S.	CAN.	Other	U.S.	CAN.	Other
One Shot Videos	$9	$12	C	$10	$12	C	$8	$10	C
"The Fuse" Cass/CD	$4	$5	C	-	-	-	-	-	-
Begining Guitar Book	$3.50	$5	C	-	-	-	-	-	-
'Big Bad & Beautiful" Live & Well Compact Disc	$3.05	$5	C

_{MAKE ALL CHECKS OR MONEY ORDERS PAYABLE TO: Dirk Price Music}
_{1237 Ashland Mine Road - Ashland, OR 97520}

Item Payment:

Check M.O. Cashiers Check.

Visa MasterCard

Shipping & Handling:

Discover

Total Enclosed:

Credit card or Check Number:
Expiration Date:

YOU MUST FILL OUT THE FOLLOWING ORDER INFORMATION

Name: Street Address:

City: State/Province: Zip/Postal Code:

Phone(home): Phone(work): Fax Number:

E-mail Address: Country:

Signature(if printing this form):

Instrument(s) you play:

Today's Date:

Optional Information:

_{Have you attended music school? (if so, name, how long, where?)}

_{If so, your major was:}

_{Have you received private lesson? (If so, what subject, how long, from whom?)}

_{Have you read any Dick Grove books? (if so, which books?)}

_{What other music instruction books have you studied?}

_{What/who are your musical influences?}

_{You short term goals?}

_{You long term goals?}

_{How did you hear about the School Without Walls?}

1-800-994-7683 or 541-552-9605
Click here to email us: Dana@BeyondChops.com v2.1