Registration Form

STUDENT’S NAME___________________________________________AGE_____

STUDENT’S NAME___________________________________________AGE_____

STUDENT’S NAME___________________________________________AGE_____

TEACHER’S NAME___________________________________________________

TEACHER’S EMAIL___________________________________________________

TEACHER’S PHONE___________________________________________________

REPERTOIRE:

Include Composer, Title, Opus, Key & Timing

BAROQUE___________________________________________________________

Classical_____________________________________________________________

Romantic/Impressionistic_____________________________________________

Modern______________________________________________________________

FEE:

$35 per student
One check per teacher; payable to SMEA
Checks from parents will not be accepted

SEND TO:

Diane Dollak
44 Horicon Ave.
Oceanport NJ 07757