©Belmont University
Summer 2012 Registration
Student's First Name:
Last Name:
Parent/Guardian Name:
Daytime Phone:
Mailing Address:
City:
State:
Zipcode:
Email Address:
Number of years of piano study:
Piano Teacher's First Name:
Piano Teacher's Last Name:
Piano Teacher's Daytime Phone:
Teacher's Mailing Address:
City:
State:
Zipcode:
Teacher's Email Address:
Do you wish to study
Classical
Jazz
Check TWO classes that interest you
sight-reading
technique
music theory
improvisation
commercial styles
Select one:
Early Bird Dormitory Before June 1: $450 (incl. 3 meals/day)
Early Bird Commuter Before June 1: $250 (incl. 3 lunches and 1 dinner)
Regular Dormitory After June 1: $500 (incl. 3 meals/day
Regular Commuter After June 1: $300 (incl. 3 lunches and 1 dinner)
In addition to submitting this form, you must also
submit a repertoire list of pieces played within the last three years.
Please email this list to:
kristian.klefstad@belmont.edu
OR
Mail to:
Kristian Klefstad
Belmont University
Young Artists Piano Invitational
1900 Belmont Blvd.
Nashville, TN 37212-3757
**EARLY BIRD APPLICATION DEADLINE: JUNE 1, 2012**