Student Registration Form 2021 Student Registration Form 2021 Step 1 of 6 16% 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's Name* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender* Male Female Instrument* Piano Violin Viola Recorder I'm a beginner (undecided) Suzuki Book Number12345678910Current Piece Polished Piece Second Instrument (if requesting additional masterclass)If you would like to add a masterclass for your second instrument, there will be a fee of $125 for the week. Piano Violin Viola Recorder Second Instrument Suzuki Book Number12345678910Second Instrument Current Piece Second Instrument Polished Piece Teacher's Name(s) Teacher's City Teacher's State Teacher's Phone Number(s) Parent(s) or Guardian(s) Name(s)* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email* Phone*Other Phone Elective Class (1st choice)*Choose oneMusic Theory IMusic Theory IISinging LessonsRhythm Toolbox (ages 7 and up)Beginning UkuleleIntroduction to Irish Fiddle (string students - ages 10 & up)Advanced Irish Fiddling (string students - ages 10 & up)Intro to Suzuki Recorder (piano and string students)Music Theory GamesArtSuzuki Creative MovementElective Class (2nd choice)*Choose oneMusic Theory IMusic Theory IISinging LessonsRhythm Toolbox (ages 7 and up)Beginning UkuleleIntroduction to Irish Fiddle (string students - ages 10 & up)Advanced Irish Fiddling (string students - ages 10 & up)Intro to Suzuki Recorder (piano and string students)Music Theory GamesArtSuzuki Creative MovementElective Class (3rd choice)*Choose oneMusic Theory IMusic Theory IISingiing LessonsRhythm Toolbox (ages 7 and up)Beginning UkuleleIntroduction to Irish Fiddle (string students - ages 10 & up)Advanced Irish Fiddling (string students - ages 10 & up)Intro to Suzuki Recorder (piano and string students)Music Theory GamesArtSuzuki Creative Movement Product NameRegistration Fee (required)* Individual Student Family Family registration already paid on a sibling form Tuition* Tuition Includes: Masterclass | Repertoire Class | Daily Recital | Enrichment | Parent Discussion GroupsOptional: Second instrument masterclass Add a second instrument masterclass Pre-Institute LessonsThe Memphis Suzuki Institute is offering a great opportunity for Suzuki students (including absolute beginners) to participate in pre-institute lessons with Master Teachers. Pre-Institute dates are listed below for each instrument/book. If you have the time, you will not want your child to miss this! Pre-Institute lessons will scheduled in one of the following times 11am, 1:00pm or 2:00pm. Please let us know your preference. Violin Book 1 (Fitzgerald) Violin Book 1 (Bossuat-Gallic) Violin Book 2 (Schubert) Piano Book 1 (Hauck) Piano Book 2 (Reed) Piano Book 6 (Adams) Recorder Book 1 (Waldo) Preferred Time (for Pre-Institute Lessons) Sibling Classes Music Theory I Music Theory II Singing Lessons Rhythm Toolbox Beginning Ukulele Introduction to Irish Fiddle Extras Music Theory Set of Cards For Music Theory class, students will receive instructions about how to make a set of music cards at home. If you prefer, a set can be received by mail for a fee of $5.00.Total Online Classes* I understand that all classes will be conducted online via Zoom.Please note that you will not be able to submit the form without first checking the box above to acknowledge your understanding of the virtual classes.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/ EmailThis field is for validation purposes and should be left unchanged.