Application Form

June

Intermezzo Chamber Music Sessions

You may fill out this form and send it electronically and mail your payment, or print it out and mail with your payment. Please make checks out to Intermezzo and mail them to:
Robyn Julyan
2166 S. Ash st.
Denver, CO 80222.

Date:
Student's Name:
Address:
E-mail:
Date of Birth:
Age:
Home Phone:
Cell Phone:
Parents'/Guardians' Names:
Instrument:
Most Recent Polished Piece:
Name of Private Teacher:
Teacher's Phone Number:
Parent or Guardian Emergency Contact Information:
T-Shirt Size- CHILD: S (6-8) M (10-12) L (14-16) XL (18-20) ADULT: S M L XL:
If you are applying as a pre-formed ensemble,** please list the names of the other group members:
	“I agree to release all photos and/or video footage to Intermezzo Chamber Music Sessions for promotion and advertising, on our website and elsewhere.”
	I am mailing payment in full ($320 by May 15 or $340 after May 15)
	I am mailing a payment of $150 with the balance due in full June 1st.

*Please note that each member of the pre-formed ensemble must apply individually.

Payment Information:

Tuition: $300

Non-refundable application fee: $20

Late application fee: $40

Total: $320 for applications returned by May 15, 2010;

$340 for applications returned after May 15.

Payment Options:

Checks are payable to Intermezzo.

Total amount of $320 or $340 after May 15
$150 with application before May 15, or $160 after May 15, with the balance due in full by June 1st.

Applicants who are not accepted into the Sessions will have their tuition refunded. The application fee is non-refundable. No refunds are given after June 17.

Main Navigation

Application Form