Registration Form
For new and existing members
Registration Details
Details of participant (student or musician)
Participant Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Day
-
Month
Year
Email
*
example@example.com
Phone Number
*
Primary Mobile Phone Contact
Format: (04) 00-000-000.
I am new member of MYME
Yes
No
Do you have a sibling in MYME?
*
Yes
No
If "Yes", what is the name of your sibling/s?
Ensemble/Band:
*
MYSO 1
MYSO 2
Fiddle Group
Chamber Strings
Concert Band
Instrument/s
*
Do you have access to your own instrument?
*
Yes
No
Current School/College
*
Please write "nil" if not appliable
Year level
*
1
2
3
4
5
6
7
8
9
10
11
12
College/University/TAFE
Adult Member
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
*
Parent/Guardian or Emergency Contact Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Primary Emergency contact
Format: 0400-000000.
Name 2 (optional)
First Name
Last Name
Email 2 (optional)
example@example.com
Phone Number 2 (optional)
Secondary Emergency contact
Format: 0400 000000.
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
*
/
Day
/
Month
Year
Date
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Submit
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