REGISTRATION FORM

MUSIC STUDIES ABROAD
1. Last Name
Nom de Famille		 *
2. First name
Prénom 		*
3. Date of Birth
(month, day, year)
Date de naissance
(Jour, Mois, ANNÉE )		 *
4. Address
Adresse 		*
5. City-State-Zip
Code - Ville - Pays		 *
6. Telephone *
7. Fax *
8. Instrument & Level
Instrument et Niveau 		*
9. School and Teacher
Ecole et Professeur		 *
11. Date (month, day, year)
(Jour, Mois, ANNÉE )		 *
12. email address
courrier électronique:
 *
13. Signature *
14. Comments / Questions
For more information & registration contact:
Dr. William Krakauer
342 West 85th Street #6C
New York NY 10024
USA

Tel: 1 (212) 724 - 7933
Fax: 1 (212) 724 - 5991

email:
wk@musicstudiesabroad.com

THANK YOU
MERCI
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