PO Box 361391
Los Angeles, CA 90036
phone (323) 934-5691

This is an application for enrollment in the Harriet Schock Online Songwriting CoursePlease print this form, provide all of the information requested, and mail it along with your check or money order for $550.00 ($500.00 if all correspondence is done by e-mail) to the address above. You may also pay by credit card. If you have any questions feel free to e-mail or call me.  Just leave a message with your questions and I'll get back to you shortly.

I look forward to working with you and helping you become remarkable at your craft!


Name __________________________________________________

Address ________________________________________________

City _________________________ State _____ Zip ____________

Phone (_____)_______________ Fax (_____)__________________

Best Time to Reach You ___________________________________

E-Mail Address ___________________________________________

Do You Prefer to Conduct this Course by Phone? ___ Fax? ___ Mail? ___ E-Mail? ___

Background

Do You Write Songs? _____ Poetry? _____ Both? _____

How Long Have You Been Writing? __________________

Has Any of Your Work Been Published? _____  If so, please include a separate note telling me a little about your published work, where it has appeared, who has performed your songs, etc.

Do You Play any Musical Instruments?  Which Ones?

______________________________________

______________________________________

Do You Sing? ______________

Do You Perform Your Own Work? __________

What Goals do You Hope to Achieve with this Course?

_________________________________________________________

_________________________________________________________

_________________________________________________________

You may also add a note telling me anything else you feel may help us work better
together during the course.

I, the undersigned, will keep these assignments confidential. I understand that my tuition is nonrefundable. I also understand I have one year to complete the course. (It usually takes ten weeks.) Otherwise, I must pay for it again to take it.


______________________________________
SIGNATURE


Please print this page and mail to the address at the top of the page.

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