Request a Donated Clarinet
Please complete this form if you or your student/family member is in need of a clarinet.
Who is requesting the instrument?
Teacher
Student
Family Member
Other
Name of person requesting the instrument donation
*
First Name
Last Name
Contact email for individual requesting the instrument donation
*
example@example.com
Name of instrument recipient
*
First Name
Last Name
Contact email for instrument recipient
*
example@example.com
Is the recipient currently a member of the ICA? (Please note this is not required.)
Yes
No
How long has the recipient been playing the clarinet?
What type of clarinet does the recipient need?
*
Beginning Bb Clarinet
Intermediate Bb Clarinet
Professional Bb Clarinet
A Clarinet
Eb Clarinet
Other
Does the recipient also need accessories? List any additional items that the recipient needs such as reeds (strength/type), sheet music, mouthpieces, etc.
What is the mailing address to where the instrument will be sent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If selected as a recipient of a donor instrument, would the recipient and/or the parent/guardian of the recipient give the ICA permission to share their clarinet journey story and their photo with the membership and the donor of the instrument on social media and in our publication The Clarinet?
*
Yes
No
Submit
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