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Registration Form Name: _______________________________________________________________________________ Address: _____________________________________________________________________________ Phone: (_______) __________________ Email: ____________________________________________ Birthday: _______ / _______ / _________ School Grade (if applicable): ___________ Instrument / Vocal Part: ________________________________ Title of selection: ______________________________________________________________________ Movement (if applicable): _____________________________ Composer: __________________________________________ Orchestral Materials Published by / Available through: ______________________________________ Name of Accompanist: ________________________________________________________________ Name of Private Music Instructor: _______________________________________________________ Phone: (_______) ___________________ Signature: ________________________________________ Registration Fee: $30 Amount Enclosed: $ ___________ (Please make checks payable to Oregon East Symphony) Participant Signature: _______________________________________________ Date: _______ / _________ / ______
Notes: (use additional sheet if required) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
MAIL, FAX, or EMAIL to: Oregon East Symphony PO Box 1436 Pendleton, OR 97801 Fax: (541) 278-6114 Email: info@oregoneastsymphony.org |