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Registration Form

Please print out this page and mail it with your audition fee to

WVYO Chamber Music Ensemble Camp
P.O. Box 206, Litchfield Park, AZ 85340-0206
Please make checks payable to West Valley Youth Orchestra
Partial payment due with application - $60
Balance by May 3 is $160/ by May 14 is $180 (Total payment: $220 if postmarked before May 3; $240 if postmarked after May 3)
Auditions are May 22, 2010 at the Desert Springs Community Church, 14440 W Indian School Dr, Goodyear, AZ 85395

Student Name:_____________________________________________________

Address:_________________________________________________________

City:________________________Zip:_________________________________

Home phone:_____________________________________________________

Parent's work phone:_______________________________________________

E-Mail:__________________________________________________________

Age:__________________Present grade level___________________________

School:_________________________________________________________

Instrument:______________________________________________________

Years studied on this instrument:______________________________________

Name, phone, and address of private teacher:_____________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Name(s) of students(s) you would like to be placed with:____________________

_______________________________________________________________

_______________________________________________________________

Parent/guardian signature:___________________________________________

Total amount enclosed:______________________________________________