CONTACT DETAILS:
Teacher's Full Name
*
Your School
*
School Phone Number
*
Please enter a valid phone number.
School Extension
Teacher Cell Number
*
Please enter a valid phone number.
Email Address
*
Confirmation Email
SCHEDULING DETAILS: Some dates are very popular, which may necessitate a date or time change for your clinic or camp.
Clinic Location
*
If the clinic is at your school, please re-type the school name, otherwise, type in the location of the clinic (eg. Camp Caroline).
Clinic Date
*
Clinic Start Time
*
AM
PM
AM/PM Option
Clinic End Time
*
AM
PM
AM/PM Option
Please Fix the Error:
The Clinic
Start Time
MUST be
BEFORE
the Clinic
End Time
.
Grade Level of Clinic
*
Please Select
Middle School/Jr High
Senior High
Community
Estimated Total Number of Participants
*
Reminder: Student to Clinician Ratio
Requested Number of Clinicians:
Conductor - Concert Band
0
0
1
2
3
4
5
Conductor - Jazz Band
0
0
1
2
3
4
5
Flute
0
0
1
2
3
4
5
6
7
8
9
10
Piano
0
0
1
2
3
4
5
6
7
8
9
10
Oboe
0
0
1
2
3
4
5
6
7
8
9
10
Bass - Electric
0
0
1
2
3
4
5
6
7
8
9
10
Clarinet
0
0
1
2
3
4
5
6
7
8
9
10
Bass - Acoustic
0
0
1
2
3
4
5
6
7
8
9
10
Bass Clarinet
0
0
1
2
3
4
5
6
7
8
9
10
Guitar - Electric
0
0
1
2
3
4
5
6
7
8
9
10
Bassoon
0
0
1
2
3
4
5
6
7
8
9
10
Guitar - Acoustic
0
0
1
2
3
4
5
6
7
8
9
10
Alto Saxophone
0
0
1
2
3
4
5
6
7
8
9
10
Drum Set
0
0
1
2
3
4
5
6
7
8
9
10
Tenor Saxophone
0
0
1
2
3
4
5
6
7
8
9
10
Violin
0
0
1
2
3
4
5
6
7
8
9
10
Baritone Saxophone
0
0
1
2
3
4
5
6
7
8
9
10
Viola
0
0
1
2
3
4
5
6
7
8
9
10
Trumpet
0
0
1
2
3
4
5
6
7
8
9
10
Cello
0
0
1
2
3
4
5
6
7
8
9
10
French Horn
0
0
1
2
3
4
5
6
7
8
9
10
Conductor - Choral
0
0
1
2
3
4
5
6
7
8
9
10
Trombone
0
0
1
2
3
4
5
6
7
8
9
10
Voice Soprano
0
0
1
2
3
4
5
6
7
8
9
10
Baritone / Euphonium
0
0
1
2
3
4
5
6
7
8
9
10
Voice Alto
0
0
1
2
3
4
5
6
7
8
9
10
Tuba
0
0
1
2
3
4
5
6
7
8
9
10
Voice Tenor
0
0
1
2
3
4
5
6
7
8
9
10
Percussion
0
0
1
2
3
4
5
6
7
8
9
10
Voice Bass
0
0
1
2
3
4
5
6
7
8
9
10
Special Requests (Eg. Quote only):
HAVE YOU CHECKED THAT ALL THE DETAILS ARE CORRECT IN THIS ORDER? If so, click "YES."
*
YES
Would you like to submit another order? If "yes", this order will be submitted, and your contact information will be pre-filled on the next order form.
*
Yes
No
I am not a robot:
*
Submit
Should be Empty: