Name_______________________________________________
Male (__) Female (__)
Address_____________________________________________
City_______________ State_______ Zip Code______________
Country____________________________ Age______________
Telephone (___)____________Fax (___)___________________
E-mail address_________________________________________
Instrument or Voice Type__________________ Years Studied____
Accomplishments_______________________________________
____________________________________________________
____________________________________________________
Teacher’s name _______________________________________
School______________________________________________
Signature of student (If student is 18 or over)
____________________________________Date____________
Signature of parent or guardian (If student is under 18)
_____________________________________Date___________
Please mail this completed form with:
1. A deposit of US $700.00 and
2. An application fee of US $100
before February 15, 2020
(US $150 after February 15, 2020)
payable to:
ARDSLEY MUSIC STUDIO (I.A.M.)
36 Willow Drive
Briarcliff Manor, NY 10510
USA
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