STUDENT MUSIC ENSEMBLE WORKSHOP

APPLICATION FORM

DEADLINE: March 15, 2010

Please include application fee of $45 (check made out to PAS) – refundable if applicant is not selected.

Please Print and Mail to: PAS Student Music Ensemble Workshop, c/o Jim Reiter, 83 Silverwood Drive, Lafayette, CA 94549.

DATE ____________________________

Student’s Name ____________________________________________________________________________

Address______________________________________________________ Apt. No.___________

City__________________________________________ZIP_____________________

Phone Number (        )____________________ e-mail_______________________________________________

School __________________________________Grade______City___________________________________

School instrumental teacher name ______________________________________________________________

Private music teacher (if any) __________________________________________________________________

Teacher’s address __________________________________________________________________________

Teacher’s phone (        )________________________ e-mail _________________________________________

INSTRUMENT______________________No. years studied ____ Certificate of Merit Level (if applicable) ______

Piece you’re studying currently________________________________________________________________

PRE-FORMED GROUP ______  INDIVIDUAL _______ (Check one)

(Note: Individual players will be assigned to a group and repertoire 5 weeks before the workshop.)

Names of players and instruments in pre-formed group (3-6 players; can include one pianist) __________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

For pre-formed groups only: NAME OF PIECE TO BE PERFORMED: (include composer, movement, key,

Op. no. and duration – limit 6 minutes)

_____________________________________________________________________________________________

AUDITION TAPE, CD or DVD of 3-4 minute duration is required for all players. Please mark with name of applicant and title of musical selection.