Registration

Name *

Name

First Name

Last Name

Nickname *

M/F: *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

Home Phone

(###)

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Cell Phone

(###)

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Email Address *

Birthdate *

Birthdate

YYYY

Age *

School *

Grade *

Other Interests/Activities *

Instrument #1

Years of Study

Teacher's Name & Telephone

Instrument #2

Years of Study

Teacher's Name & Telephone

How did you hear about the Young Organist Collaborative? *

Why do you want to study the organ? *

Church or Congregation (information may be helpful with placement, securing practice space, and fundriasing) *

Parent/Guardian Information

Parent/Guardian Name(s) *

Home/Cell Phone #1 *

Home/Cell Phone #1

(###)

###

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Email Address #1 *

Home/Cell Phone #2

(###)

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Email Address #2

Message