Thousand Oaks Philharmonic

Appassionata Program Registration

2018 - 2019

 

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
  • Strings

Program Fee

Select the Fee corresponding to the program. It will be assigned to the Credit Card charge at the bottom of the completed form.
Donation Amount*
  • Pianist $200
  • Strings $150

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
Music Teacher's Name
Music Teacher's Phone number
Music Teacher's email
Accompanist Name
Accompanist Phone Number
Accompanist email

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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