Existing Member Annual Renewal Form

Registration Form

For new and existing members
Registration Details

Details of participant (student or musician)
Participant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

DayMonthYear
Email*
example@example.com
Phone Number*
Primary Mobile Phone Contact
Do you have a sibling in MYME?*

YesNo
If "Yes", what is the name of your sibling/s?
Ensemble/Band:*

MYSO 1MYSO 2Fiddle GroupChamber StringsConcert BandSenior Brass Band
Instrument/s*
Do you have access to your own instrument?*

YesNo
Current School/College*
Please write "nil" if not appliable
Year level*
Current Instrumental Music Teacher and/or Private Instrumental Teacher*
Please write "nil" if not applicable
I confirm that I, as the participant, and my parent/guardian (if applicable), have read the MYME Privacy and Media Release Policy and:

I give permission to be filmed for marketing by MYME members, and to have said images displayed on MYME electronic mediate outlets and/or DVD media.I prefer to be photographed/filmed in a group performance only (i.e. no solo performances).
Signature*

Clear
Parent/Guardian or Emergency Contact Details
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Primary Emergency contact
Name 2 (optional)

First NameLast Name
Email 2 (optional)
example@example.com
Phone Number 2 (optional)
Secondary Emergency contact
Billing details

Please provide a MONITORED email address for billing purposes.
Billing Email address*
Please provide a monitored email address
By checking this box, I confirm that I am over 18 years of age or have parental/guardian consent to register for MYME.*

Yes
Date*

DayMonthYear
DateHourMinutesAM/PM Option
Should be Empty:

Registration Form

Registration Details

Parent/Guardian or Emergency Contact Details

Billing details