BSS Summer Workshop August 12 - 16, 2019 Chamber Music Program

Fill out the form below and return it with the student information form and full payment to:

Buffalo Suzuki Strings, 4 Webster St., N. Tonawanda, NY 14120

Deadline for registration: May 17, 2019 Applications received after this date will be accepted based on

availability.

Early registration bonus: Sign up before May 1 and receive a discount!

No refunds after June 15.

A workshop T-shirt is included for everyone: please select a size.

Youth XS S M L Adult S M L XL

Payment (circle): check cash credit card

Amount: $____________ Zip Code: ____________

CC# ___________________________________________

Expiration _______________ Security code ___________

Signature________________________________________

Please fill out this form in its entirety and return it with your full payment. No refunds after June 15.

One student per form.

STUDENT INFORMATION

Name: ______________________________________ Age: ________

Address: _________________________________________________

Parent(s) Names: __________________________________________

Phone: ___________________ E-mail: _________________________

Instrument: ________________ Teacher: _______________________

CHAMBER MUSIC PROGRAM INFORMATION Please complete to ensure proper ensemble placement.

Current working piece: ______________________________________

Composer: _________________________ NYSSMA Level: ________

Violin students: are you willing to play viola?

In orchestra __________ In a chamber ensemble _________

Class Tuition

Discount tuition, prior

to May 1 Amount Paid

Chamber Music Violin - late book 5 and up Advanced viola, cello, & piano $375 $350 $____________