Our Own Songs Registration Form

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Our Own Songs Registration Form - Spring 2021

Thank you for your interest in Our Own Songs: Songwriting for Queer & Trans Teens!

This class is for ages 14 - 18. We will meet online at 4 - 5:30 pm pacific time on Tuesdays, April 20th - May 18th, 2021.

You can find full info on the class here: https://www.eliconley.com/group-classes.html#teen

If you have any questions, please contact me at SingWithEli@gmail.com.

First Name: *

Last Name: *

What gender pronouns do you go by? (i.e. she/her, they/them, he/him, ze/hir, etc) *

Phone Number: *

Is it okay to send text messages to this number? *

Yes

Other:

E-mail: *

How old are you and what grade are you in? *

Where are you located (city & state/province)? *

Parent or Guardian's Name (if applicable):

Parent or Guardian's Phone Number (if applicable):

Parent or Guardian's E-mail Address (if applicable):

This class is for queer, transgender, and questioning people, and kids from queer families. How do you identify? *

How did you hear about this class? (My friend Mary Smith, a flyer at Peet's Cafe, Yelp...) *

Who are some of your favorite bands and musical artists?

What are you hoping to get out of participating in this class? *

Have you ever written songs before, or will this be your first time? What other kinds of creative writing do you like to do (poems, short stories, essays, etc)? *

What instrument(s) and/or software do you use to make music (if any)? *

Do you have any access or learning needs you would like me to be aware of?

This class is offered on a sliding scale. The actual cost of the class is $250. Spaces below that rate are limited. Please read through each tier below before choosing what rate you will pay.

$250 is the actual cost of the class. Unlimited spots available. If you choose a rate below this tier you are receiving a discount.

$325 is the Pay-It-Forward rate. Unlimited spots available. This rate is higher than the actual cost of the class. That extra money allows me to offer spots on the lower end of the sliding scale. It's an opportunity to not only take the class, but also help make it accessible to more folks.

$175 is the middle rate. 3 spots available. This rate is for those who are able to meet their basic needs but have little-to-no expendable income. Paying for this class may qualify as a sacrifice, but it would not create hardship.

$100 is the low rate. 2 spots available. This rate is for those who struggle to meet basic needs and paying more for this class would be a significant hardship.

Full Scholarship - 2 spots available. This is for folks who would only be able to participate if they receive a full scholarship.

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To complete your registration and hold your spot in the class, please pay the class fee you selected above. How will you pay? *

Venmo to @Eli-Conley (Phone number 510-559-0301)

Paypal at this link: paypal.me/SingWithEli (Please do it as "friends and family" to avoid added fees.)

I am requesting a full scholarship.

The deadline to withdraw from the class and receive a refund is April 19th. If you withdraw after April 19th, you will not receive a refund. *

I understand and agree.

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Do you have any questions for me or anything else you'd like to say?

Thank you for signing up for Our Own Songs!

Please submit this form and check your e-mail for confirmation.

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