Full Name

Age

Date of Birth

Gender Select Gender Male Female

Occupation

Email

Home Phone

Mobile Phone

Address

Address 2

City

State Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming N/A

Zip/Postal Code

Country

Name of person who would be financially responsible for your tuition payment

Email

Home Phone

Mobile Phone

Parent/Guardian/Emergency Contact Full Name

Email

Home Phone

Mobile Phone

Have you attended Camp MMW in the past? Yes No

Please list allergies

Please list special dietary requirements

Do you have any medical conditions of which our staff should be made aware? Yes No

If yes, please describe

Instrument to be played at Camp

How long have you been playing?

Are you currently taking lessons, or have you taken lessons? Yes No

Name(s) of teacher(s)

What kinds of music do you play?

How often do you practice (hours per day/week)?

What other instruments do you play?

Have you studied, and/or, do you know music theory?

Can you sight read music? Yes No

How did you find out about Camp MMW?

Tell us briefly why you like performing, and what your goals are (500 words or less)

MP3 Demo 1 (8 MB max)

MP3 Demo 2 (8 MB max)