Concerts Plus Registration Form
Closing Date Friday 10 August
Please return this form with full payment to Suzuki Music before Friday 10 August.
Applications and payments received after this date will incur a late fee of $7.50 per family.
Parent Name _____________________________ Memb No _______ Phone ________________________
CHILD 1
Name __________________________________________ Date of Birth _________________
Concert Time
(see program)
____________ Enrichment Activity Time
(see program)
____________
Piano Teacher to complete:
(Please note that pieces must be at concert standard)
Concert Piece Book ______Title
(incl Movement)
_________________________________________________
Composer _____________________________________________________ Duration __________________
Teacher Name ________________________________ Teacher Signature _________________________
PAYMENT DETAILS
Cost $30 one child, $45 two children, $55 three children
(Late Fee $7.50 per family must be added for all registrations received after Friday 10 August)
Total Amount $ _____________
Cheque/Money Order Credit Card* (Mastercard / Visa)
[Payable to Suzuki Music} * Credit card transactions will incur an additional 2% surcharge
Card No
_ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _
Expiry
Date
_ _ / _ _
SUZUKI MUSIC
PO Box 439 Kew East VIC 3102
((03) 9859 0433 Fax (03) 9859 0477 Email: info@suzukimusic.org.au
Suzuki Talent Education Association of Australia (Vic.) Inc. Reg. No. A5744; ABN 14 080 413 955
CHILD 2
Name __________________________________________ Date of Birth _________________
Concert Time
(see program)
____________ Enrichment Activity Time
(see program)
____________
Piano Teacher to complete:
(Please note that pieces must be at concert standard)
Concert Piece Book ______Title
(incl Movement)
_________________________________________________
Composer _____________________________________________________ Duration __________________
Teacher Name ________________________________ Teacher Signature _________________________
CHILD 3
Name __________________________________________ Date of Birth _________________
Concert Time
(see program)
____________ Enrichment Activity Time
(see program)
____________
Piano Teacher to complete:
(Please note that pieces must be at concert standard)
Concert Piece Book ______Title
(incl Movement)
_________________________________________________
Composer _____________________________________________________ Duration __________________
Teacher Name ________________________________ Teacher Signature _________________________
