Thousand Oaks Philharmonic

Appassionata Program Registration

2016 - 2017

 

Each item marked * is required to complete the registration.

Please gather all information before starting.

 

Please Select One Program for One student.

 

 

Program Selection*
  • Pianist
  • Instrumentalist & Strings Grade 1-8
  • Instrumentalist & Strings Grade 9 & above

Grade level corresponding Fee

Select a Fee corresponding to the Student Grade. It will be assigned to the Credit Card charge at the bottom of the completed form.
Donation Amount*
  • Pianist $300
  • All Instrumentalists & Strings $250

Parent Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Student Information

Please give the Student's details below 

Student's First name*
Student's Last name*

Please use this Date format mm/dd/yy

Student Date of Birth
Student's email address
School Attending
Student's School Grade
Instrument & Level of Appassionata Program of choice
Music Teacher's Name
Music Teacher's email
Music Teacher's Phone number

The Thousand Oaks Philharmonic may photograph and/or video participants and patrons for promotional and educational purposes. Attending any of our events grants us permission to use these images.

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

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