International Academy of Music
                  Application Form
             Saint Petersburg, Russia

Name_______________________________________________

Male (__)             Female  (__)

Address_____________________________________________

City_______________ State_______  Zip Code______________

Country____________________________ Age______________

Telephone (___)____________Fax  (___)___________________

E-mail address_________________________________________

Instrument or Voice Type__________________ Years Studied____

Accomplishments_______________________________________

____________________________________________________

____________________________________________________

Teacherís 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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