Student Registration Form Early Bird deadline (save $25) – Register by April 1, 2019 At the end of the form (after you click on the “Submit” button, you will be directed to PayPal to pay with either PayPal or a debit/credit card. Student Registration Form 2019 Step 1 of 7 14% Student's Name* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender*MaleFemale Instrument(s)* Piano Violin Viola Cello Recorder Other Suzuki Book Number12345678910Current PiecePolished PieceOrchestral Experience (string students only) None Institute Youth Orchestra School Church Other Teacher's NameTeacher's CityTeacher's StateTeacher's Phone Number Parent(s) or Guardian(s) Name(s)*Parent/Guardian attending the Institute*Students must be accompanied by an adult at all times during the Institute. Local students ages 12 and above may attend without an adult. Please indicate the on form.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email* Phone*Other Phone T-shirt Size*T-shirt is included in tuitionChild XSChild SChild MChild LAdult SAdult MAdult LAdult XLAdult XXLElective Class (1st choice)*Orchestra (string students only)Chamber MusicIntro to Suzuki Recorder (piano and string students)World Drumming (ages 7 and up)OrffCreative MovementBeginning UkuleleIntermediate UkuleleMusic Theory GamesArtGraphic Arts Photo ImagingFiddle (string students only)Family ChorusConductingSongwritingElective Class (2nd choice)*Orchestra (string students only)Chamber MusicIntro to Suzuki Recorder (piano and string students)World Drumming (ages 7 and up)OrffCreative MovementBeginning UkuleleIntermediate UkuleleMusic Theory GamesArtGraphic Arts Photo ImagingFiddle (string students only)Family ChorusConductingSongwritingElective Class (3rd choice)*Orchestra (string students only)Chamber MusicIntro to Suzuki Recorder (piano and string students)World Drumming (ages 7 and up)OrffCreative MovementBeginning UkuleleIntermediate UkuleleMusic Theory GamesArtGraphic Arts Photo ImagingFiddle (string students only)Family ChorusConductingSongwriting Product NameRegistration Fee (required)* Individual Student Family Family registration already paid on a sibling form Tuition* Full Day Half Day (3 and 4 year olds) Sibling Classes Orchestra (string students only) Chamber Music Intro to Suzuki Recorder (piano and string students) World Drumming (ages 7 and up) Orff Beginning Ukulele Intermediate Ukulele Music Theory Games Art Graphic Arts Photo Imaging Fiddle (string students only) Family Chorus Conducting Songwriting Additional Pizza Dinners One Additional Pizza Dinner Two Additional Pizza Dinners Three Additional Pizza Dinners Four Additional Pizza Dinners Five Additional Pizza Dinners Additional T-shirts One Additional T-Shirt Two Additional T-Shirts Three Additional T-Shirts Four Additional T-Shirts Five Additional T-Shirts Please indicate size(s)Early Bird Discount (if registered and paid in full by April 1) Early Bird Total $0.00 Consent* I have read and understand the Memphis Suzuki Institute Policies and I agree to abide by the regulations stated there. I accept complete responsibility for the charges and fees that may be incurred. Please note that you will not be able to submit the form without first checking the box above to accept our policies. You may view our policy by clicking on this link: https://suzukimemphis.com/policies/ NameThis field is for validation purposes and should be left unchanged.