PAL/MMB BAND SUMMER MUSIC CAMP REGISTRATION FORM

(PLEASE PRINT ALL INFORMATION)

STUDENT’S NAME________________________________________________

PARENT’S NAME_________________________________________________

ADDRESS_______________________________________________________

CITY_____________________________ ZIP____________________________

HOME TEL__________________ CELL PHONE_________________________

WORK TEL_______________________ EMAIL__________________________

SCHOOL NOW ATTENDING_____________________________ GRADE_____

SCHOOL ATTENDING IN THE FALL___________________________________

INSTRUMENT: (please circle one choice)

FLUTE           CLARINET    OBOE             ALTO SAXOPHONE          

TENOR SAXOPHONE       TRUMPET     FRENCH HORN      BARITONE HORN

TROMBONE             TUBA             SNARE DRUM KIT              BELLS

Please check the statement that applies:

____I own my own instrument.

____I will be renting an instrument.

Student’s Signature_________________________________________________

Parents Signature__________________________________________________

Please return this form by Friday, June 27, 2008 to:

Mr. Art Martin

Coordinator

PAL/MMB Summer Band Music Camp

230 Lago Circle, Apt. 101

West Melbourne, FL  32904