IMA PIANO

Student Name:*

First NameLast Name

Student Age by June 11, 2022 *

Student Email Address:*

Email

Teacher or School Name*

Teacher Phone Number*

Area CodePhone Number

Teacher Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Teacher Email Address:*

Email

Piano

Senior Open (Sunday Only) DO NOT SELECT A DAY PREFERENCE!

Virtuoso (Sunday Only) Use this option if you wish to play a different piece not in the suggested list. DO NOT SELECT A DAY PREFERENCE!

Day Preference (add $1)

SaturdaySundayNo Day Preference (No extra fee)

COVID DISCLAIMER

ATTENTION!!!! COVID INFORMATION: If the IMA Competition is unable to be held in person, the contest will be switched to a virtual format as in 2021.

NO REFUNDS will be given.

If the contest is held “in person”, ALL ATTENDEES MAY BE REQUIRED TO WEAR A MASK.

If so, no one will be admitted without a mask. Masks may be removed at
the student's discretion while performing. Students should use hand sanitizer immediately prior to performing.

The IMA will not be held responsible should any attendee contract Covid.

I have read the COVID disclaimer and agree to the terms.

Pay by Check

Member $32Non-Member $37Day Preference Add $1

Mail check to:

IMA

C/O Marybeth Tokarz

11147 84th PL.

Willow Springs, IL 60480

Pay ONLINE

Member Registration$32.00

Choose this option if your instructor/school is a member of IMA

Non-Member Registration$37.00

Choose this option if your instructor/school is NOT a member of IMA

Day Preference$1.00

If you selected a specific day you must pay the $1 fee. Senior and Virtuoso students automatically play on Sunday and do not pay the fee.

Total $0.00

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Debit or Credit Card

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

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