Please enable JavaScript in your browser to complete this form.FILL OUT THIS FORM TO RESERVE YOUR GRACELAND PERFORMANCE BLOCK!Name *FirstLastEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNumber of students performing *I agree to pay the minimum fee for the 10 minute performance block, without exceeding the 10 minute performance block. These payments will be made in two payments of $249 billed 30 days apart beginning 12/01/21 to the card I designate below. *I agreeI dont agreeI understand that participation is contingent upon remaining a current Miami Berpro Music Academy® Student, and that cancellation of Lessons will result in forfeiture of my performance block without refund. * *I AgreeI don't agreePlease type your initials in the spaces below:I understand that all fees are non-refundable without exception *I understand I am responsible for myself and/or my Child for the event. *I understand that Miami Berpro Music Academy is not responsible for student travel and accommodations. *Payment: *Option A: Please Charge the Card You Have on FileOption B: Please Charge other Card (Call Us)Comment or Message *By Typing my Full Name on this form I agree to allow Miami Berpro Music Academy to charge my credit card designated above for the amounts and duration checked above. Charges will occur conveniently 30 days apart. I agree and understand this registration is non refundable for any reason. I agree and understand that Miami Berpro Music Academy® is not responsible for the supervision of me or my Child. *I UnderstandType your Full Name *Submit