International Academy of Music
                  Application Form
           Castelnuovo di Garfagnana

Name_____________________________________________

Male (__)             Female  (__)

Address___________________________________________

City_______________ State_______  Zip Code____________

Country____________________________ Age____________

Telephone (___)____________Fax  (___)_________________

E-mail address_______________________________________

Instrument _____________________ Years Studied__________

Accomplishments_____________________________________

__________________________________________________

__________________________________________________

Teacherís name _____________________________________

Requested teacher ___________________________________

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 March 1, 2017
                                   (US $150    after   March 1, 2017)
                                payable to:

ARDSLEY MUSIC STUDIO
545 Saw Mill River Road, Suite 3D
Ardsley, NY 10502
USA


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