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Suzuki - PDApplication Form

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Suzuki - PDApplication Form
S U Z U K I M U S I C
AUTUMN FESTIVAL 2 0 0 4
Presented by
Suzuki Talent Education Association of Australia (Vic) Inc
Reg. No. A5744 ABN 14 080 413 955
PROFESSIONAL DEVELOPMENT
ENROLMENT FORM
Closing date for Enrolments 5 March 2004
Suzuki Music
170 Southbank Blvd, Southbank, Victoria 3006
Phone 03 9681 6933 Fax 03 9681 6977
info@suzukimusic.org.au
Contact Details
Given Name ________________________ Family Name _____________________________ Membership Number __________________
Address ______________________________________ Suburb _______________________ State _________ Postcode ___________
Phone Home ____________________ Work ____________________ Mobile _____________________ Fax___________________
Enrolment Details
Accredited Suzuki Teacher
Teacher Trainee
(please tick one)
Instrument ______________________________________ Accreditation Level ___________________________________
Instrument ______________________________________ Accreditation Level ___________________________________
Private Lessons
I would like a 30 minute private lesson (Cost $72 with International Tutor, $48 with Australian Tutor). Please note that lessons are limited and
will be allocated in order of receipt.
My preferred tutors are:
1. ____________________________________________ 2. ____________________________________________
Fees
Enrolment at the Autumn Festival is open only to financial members of Suzuki Music. You may subscribe or renew membership by
including subscription payment with your enrolment.
Please enter the amount due in the right hand column and the total amount at the bottom.
Suzuki Music Membership
Renewing Members
Amount Payable
Membership (1 year)
$120
$
ISA Membership (optional)
$25
$
PD Registration
Standard
(until 5 Mar)
Early Bird
(until 6 Feb)
Amount Payable
Professional Development
(Includes lunch each day)
$327
$294
$
Late fee (after 05 March)
$44
$
Private Lesson - Int'l Tutor
$72
$
Private Lesson - Aust Tutor
$48
$
Total:
$
Payment Details
Cheque payable to Suzuki Music Credit card BANKCARD / MASTERCARD / VISA
Card Number
_ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _
Expiry date
_ _ / _ _
Name of Cardholder
__________________________________
Signature
____________________________________________
*FEE VARIATIONS
Primary trainees
enrolled in the first year of their
course in 2004 are eligible for a 50% rebate of the
Early Bird rate after completion of a minimum of 10
hours of voluntary work for the Autumn Festival.
Please contact the office to register your interest.

Victorian Teacher Trainers who will be attending
ARE required to register but do not pay for
Professional Development.
Interested teachers who are not accredited or trainee Suzuki teachers may enrol as teacher observers on the appropriate
enrolment form.





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