Registration

Name:* 

Email address:  *

Gender:  *SELECT*  Male  Female 

Age (as of December 31, 2010): 

Address: 

Town/City: 

Postal Code: 

Phone #:* 

Program:  *Please choose one* Musical Beginnings (ages 6 - 8) Instrumental Beginnings (ages 8 - 11) Choral Instrumental

Instrument:  Select flute clarinet oboe alto saxophone tenor saxophone baritone saxophone soprano saxophone french horn trumpet trombone baritone tuba percussion

Years Played:   
Years of Private Instruction: 

School: 

School Grade Completed in 2009: 

Adult Shirt Size:  *Please choose one*  XLarge  Large  Medium  Small 

In case of emergency contact: 

Phone #: 

Family Doctor: 

Phone #: