Name_____________________________________________

Male (__)             Female  (__)

Address___________________________________________

City_______________ State_______  Zip Code____________

Country____________________________ Age____________

Telephone (___)____________Fax  (___)_________________

E-mail address_______________________________________

Instrument _____________________ Years Studied__________

Accomplishments_____________________________________

__________________________________________________

__________________________________________________

Teacher’s name _____________________________________

Requested teacher ___________________________________

School ____________________________________________

☐ Advanced Violin Studies with Michael and Irina Tseitlin


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, 2024
                                   (US $150    after   March 1, 2024)
                                payable to:

ARDSLEY MUSIC STUDIO
36 Willow Drive
Briarcliff Manor, NY 10510
USA