2024 Musician as Citizen Registration Form 2024 Musician as Citizen registration form Please fill out the form below. An application deposit of $50 is required to submit the form. If accepted, we will send you an invoice with the balance due. Participant Name(Required) First Last Participant Age(Required) Participant Email(Required) Participant Phone(Required)Personal Pronouns She/Her/Hers He/Him/His They/Them/Theirs T-Shirt Size(Required) Youth Large (14-16) Adult Small Adult Medium Adult Large Adult X-Large Please note T-shirts run small and shrink!Participant Address(Required) Street Address City State / Province / Region ZIP / Postal Code Parent/Guardian Name(Required) First Last Parent/Guardian Email(Required) Parent/Guardian Primary Phone(Required)Parent/Guardian Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent 2 Name First Last Parent 2 Primary PhoneParent 2 Email Parent 2 Address (if different than participant) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Instrument and Years Studied(Required) Teacher Name If you do not have a current teacher, please use N/ATeacher Phone(Required)Teacher Email Chamber Music Studied (optional)Photo/Video Permission(Required) Yes No In the event that participants in the program may be included in any newspaper, radio, television, internet publicity, or other materials promoting the program, please indicate your preference. Submission of this form will serve as your signature.Camp SessionsPlease check the box next to the week(s) you plan to attend and if you want ensemble coaching.Camp Sessions Week 1: July 8-12 Week 2: July 15-19 Both weeks Coaching(Required) With coaching No coaching PaymentApplication Fee Price: IMPORTANT: You must pay the application fee now to submit the application.Total The application deposit must be paid online to accept this application. Enter your credit card information to make a secure payment. If you choose to pay the balance at a later date, you will receive an invoice. Please email Tracy Kraus (tracy@worcesterchambermusic.org) or call the office at 508-926-8624 if you have any problems with the online form. Thank you!Payment MethodCredit CardPayPal CheckoutMasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
