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THE CLARINET AND SAXOPHONE PERFORMANCE COURSE 2011

Printable booking form

Please complete one application form per person
Full Name (Dr/Mr/Mrs/Miss/Ms)* *delete as appropriate

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Address:___________________________________________________________

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Home Telephone No.____________________________________

Work/Daytime No.______________________________________

Mobile No.____________________________________________

Email______________________________________________________

Instrument___________________________________________

Approx. standard (Minimum Level Grade 6)
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    En-suite (5 nights inclusive of meals, tea and coffee) £550.00

    Standard (5 nights inclusive of meals, tea and coffee) £465.00

   Shared standard (joint booking for family or friends) £450.00 per person

    Non-residential (inclusive of meals, tea and coffee) £350.00

Enclosed Cheque for full amount £____________________

Enclosed Cheque for 50% £_____________________
(Balance due by June 31st)

Please list any information that may help us, e.g. details of previous performing experience, etc.

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Special dietary requirements:

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    Vegetarian

Please list any medical conditions or allergies that we should know about:

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If under 18, Parent/Guardian should please complete the following details:

Age of Child____________________________________________

Date of Birth___________________________________________

Emergency Daytime No._________________________________

Please enclose a non-refundable 50% (unless due to illness) deposit
payable to The Clarinet & Saxophone Performance
Course Summer School.

Signed_________________________________________________

Date_____________________________

Please send this application form and cheque to:
The Clarinet & Saxophone Performance Course
58 Crescent Road,
Upton Manor,
London E13 0LT