Special Plaque Order Form

Special Plaque Order Form

(Early Back, Advanced Bach, Sonatina, Sonata, Founder)
PROGRAMS WILL NOT BE CHECKED NOR MEDALS AWARDED IF THIS APPLICATION IS NOT COMPLETED!!
Please list names, type of plaque, and grade received ("C" over "A") for pupils who wish to apply for the special plaques (Early Bach, Advanced Bach, Sonatina, Sonata, Founder). Return this card with the fee of $25.00 per plaque, and a copy of each pupil's audition report card and stub (Pre-approval form NOT required for Founder applicants) by July 1 if you wish publication in Piano Guild Notes. The application fee of $25.00 includes the cost of the plaque but is not payment for express mail handling.
Fill & Send This Form After Auditions
Teacher Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Teacher’s Email*
example@example.com
Teacher’s Phone Number*
Please enter a valid phone number.

Fill & Send This Form After Auditions