Student's Name *

First Name

Last Name

Parent's Name (If the student is a minor)

First Name

Last Name

Enrollment Status *

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Returning Student

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Address

Address 1

Address 2

City

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Term *

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Fall 2022

Winter 2023

Spring 2023

Choose your class(es) *

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Khmer Language Class for Children

Khmer Language Class for Adults-Beginner Level 1

Khmer Language Class for Adults-Beginner Level 2

Khmer Language Class for Adults-Intermediate

Pinpeat Music Class

Khmer Traditional Music

Khmer Dance Class for Children and Teens

Method of Payment *

Please choose your payment method. We are currently not accepting cash payments. If you are paying by check, please make is payable to National Cambodian Heritage Museum & Killing Fields Memorial. Our mailing address is 2831 W Lawrence Ave | Chicago, IL 60625.

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Date of Registration *

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