Dulles Town Center Mall – 2014 Holiday Concert
Application and Registration Form
Date: Friday-Sunday, December 12-14
Postmark Deadline: November 7, 2014
Registration Deadline: November 12, 2014
Location: Dulles Town Center Mall – upper level, Lord & Taylor entrance
Fee: $15 per entrant
Fee for ______Entrants x $15 = $______
Total Fee in one check payable to Fairfax-Loudoun Music Fellowship $______
Send this form and FLMF payment to: Sandy Baker
41635 Browns Farm Lane
Leesburg, Virginia 20176
You may also email the form to: and mail your payment or give it to me by the November 12th meeting.
Teacher ______
Phone ______
Address______
Email ______
Day/Time Preference:
First Choice ______
Second Choice______
Listing the pieces and timing them will help in planning for your allotted time.
You may wish to prepare a program for your students.
Student Name:______
Total Playing Time:______
Pieces Performing ______
Student Name:______
Total Playing Time:______
Pieces Performing:___
Student Name:______
Total Playing Time:______
Pieces Performing:______
Student Name:______
Total Playing Time:______
Pieces Performing:______
Student Name:______
Total Playing Time:______
Pieces Performing: ______
Student Name:______
Total Playing Time:______
Pieces Performing:______
Student Name:______
Total Playing Time:______
Pieces Performing______
Student Name:______
Total Playing Time:______
Pieces Performing:______
Student Name:______
Total Playing Time:______
Pieces Performing:______
Student Name: ______
Total Playing Time ______
Pieces Performing: ______