si piano festival 2017 registration form-piano 4-hands...

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Page 1: SI Piano Festival 2017 Registration Form-Piano 4-HANDS ...cola.siu.edu/music/_common/documents/piano-festival/reg-form... · Title: SI Piano Festival 2017 Registration Form-Piano

SI Piano Festival 2017 Registration Form: PIANO 4-Hands/ENSEMBLE

Name 1 (please print) _______________________________________ Age ______ Instrument __________

Name 2 (please print) _______________________________________ Age ______ Instrument __________

Name 3 (please print) _______________________________________ Age ______ Instrument __________

Name 4 (please print) _______________________________________ Age ______ Instrument __________

Name 5 (please print) _______________________________________ Age ______ Instrument __________

Contact Person’s Address_____________________________ City________________ State ___ Zip______

Phone Number(s): Home______________________________ Cell ________________________________

E-mail Address __________________________________________________________________________

Name of School ____________________________________ Your Current Level in Piano ______________

Name of Current Piano Teacher (if applicable) _________________________________________________

Please bring an original copy of your repertoire to the Clinic, and also to the Masterclass if chosen to play in one of the two Masterclasses taught by SIU Piano Faculty; participants for the Masterclasses will be selected during the festival; Masterclass is free and open to the public

Repertoire (One or Two pieces for a 20-minute Clinic at $15 per group):

1. Title _________________________________________________________________________________

Composer: _____________________________________________________ Duration ___ minutes

Your Piano Teacher or Your Comments to indicate problem areas or focal points (if any) for Repertoire #1:

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

2. Title _________________________________________________________________________________

Composer: _____________________________________________________ Duration ___ minutes

Your Piano Teacher or Your Comments to indicate problem areas or focal points (if any) for Repertoire #2:

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Signature of Your Piano Teacher (preferred), or Parent/Guardian/Self________________________________

Make checks payable to SIU (with ‘Piano Festival’ listed in the memo line) – send this form and the registration fee of $15 for a 20-minute Clinic per group, postmarked by October 5th to guarantee your spot, to: Dr. Junghwa Lee ([email protected]), SI Piano Festival Director, School of Music, Mail Code 4302, Southern Illinois University, Carbondale, Illinois 62901, (618) 536-8742.