User account

Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password *

Confirm password *

Provide a password for the new account in both fields.

Primary Account Holder/Billing Name

Billing Address

Country *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP code *

Additional Information

Add Family Members

Students

Students		Order
	Relationship to account holder First Name Last Name Email Gender Ethnicity Each year, foundations & corporations supporting MIC with grants ask us to provide information about the race & ethnicity of our student. This voluntary information is confidential and will only be used to form aggregate numbers for our programs. Birthdate School Name and City Grade Instrument	Weight for row 1

Add students who will be taking MIC classes.

Additional Guardians

Guardian	Order
	Guardian	Weight for row 1

Leave this field blank

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