Central Valley Youth Symphony Association

Registration Form

2017-2018 Season

Date:

Orchestra: (Please Circle) Full Symphony Preparatory

Semester applying: (Please Circle) Fall 2017 Spring 2018 Both

Please print clearly:

Student’s Name

Please Circle Male Female (optional, for grant writing purposes only)

Ethnicity (optional, for grant writing purposes only)

Home Phone ___

Address

City/Zip

Mother’s Name Cell Number

Father’s Name Cell Number

Student’s Cell (Optional)

Mother’s Email Address

Father’s Email Address

Student’s Email Address (Optional)

Instrument How Long?

How many previous years playing with CVYSA? Age

Grade in School Name of School

School District

School music teacher______

Private music teacher

Do you play in your school instrumental program **______

If not, why?

** Please Note: CVYSA strongly encourages students to participate in their school music programs.

CVYSA will contact you with important updates, including our Newsletter, via email. If you do not have an email, please indicate how else we may reach you:

______

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Student’s Name ______

Please check and pay for all that apply:

TUITION / Amount Due / Amount Paid
Full Symphony Fall Semester only / $300
Full Symphony Spring Semester only / $300
Full Symphony Fall & Spring Semesters / $450
Preparatory Orchestra Fall Semester / $250
Preparatory Orchestra Spring Semester / $250
Preparatory Orchestra Fall & Spring / $400
ADDITIONAL REQUIREMENTS
Friends of CVYSA/$250 or more*
*Yearly participation in the Friends of CVYSA will provide 4 tickets to each of our concerts at no charge / $250
REQUIRED CONCERT WEAR
Ordering information enclosed. Symphony wear must be ordered directly
from Stage Accents,http://www.stageaccents.com
GRAND TOTAL

Cash______Check Number______Money Order Number______

For Credit Card Payment :

Number______Expiration Date______

Credit Card Billing Zip Code ______Security Code on Back of Card______

Signature______

All fees are due no later than the first rehearsal of the season

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Student’s Name ______

Please list below, your present music instructors (this should include school, private lessons and summer programs:

Instructor______Instructor______

Address______Address______

City/Zip______City/Zip______

Phone Number______Phone Number______

Instrument______Instrument______

Instructor______Instructor______

Address______Address______

City/Zip______City/Zip______

Phone Number______Phone Number______

Instrument______Instrument______

Please list below 4 persons we may contact by letter for our Fall 2017 fund raising efforts. Possible ideas are relatives, friends, and persons you do business with such as your doctor, dentist, lawyer, or merchant. These funds are greatly appreciated and used solely for students and symphony enrichment.

Name______Name______

Address______Address______

City/Zip______City/Zip______

Name______Name______

Address______Address______

City/Zip______City/Zip______

Thank you for taking the time to complete this information…Remember if you have questions, please contact CVYSA at (888) FOR-CVYS.

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Revised May 24, 2017