Teacher 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. Teacher Registration Form 2019 Step 1 of 3 33% Participant's Name* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender* Male Female Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 Country Email* Phone* SAA Membership NumberTraining Status* Participant Auditor If you are a high school student, what is your planned date of graduation?Please list previous Suzuki training. Include units, dates, instructors and institutes or workshops attended.T-Shirt Size (included in tuition)*Adult SmallAdult MediumAdult LargeAdult X-LargeAdult 2X-Large Product NameRegistration Fee* Registration Fee (required, except if you are registering for ECC only) Registering for ECC only SAA Course Registration Fee*If you are taking one or more training units, you must pay the SAA Course registration Fee(s). It is required by the Suzuki Association of the Americas in order to register the course with them. SAA Course Registration Fee (one unit) SAA Course Registration Fee (two units) I'm registering for ECC only EVERY CHILD CAN!No registration Fee required if registering for ECC only Every Child Can! PIANO TEACHER TRAININGTuition includes: Institute T-shirt and Sunday Pizza Dinner Piano Unit 1 ECC & Piano Unit 1 (save $25) Piano Unit 2 Piano Unit 3 Piano Units 2 & 3 (save $25) Piano Unit 4 Piano Unit 5 Piano Units 4 & 5 (save $25) VIOLIN/VIOLA TEACHER TRAININGTuition includes: Institute T-shirt and Sunday Pizza Dinner Violin Unit 1 ECC & Violin Unit 1 (save $25) Violin Unit 2 Violin Unit 3 Violin Units 2 & 3 (save $25) Violin Unit 4 Violin Unit 6 Violin Units 4 & 6 (save $25) RECORDER TEACHER TRAININGTuition includes: Institute T-shirt and Sunday Pizza Dinner Recorder Unit 2 Recorder Unit 3 Recorder Units 2 & 3 (save $25) Additional Pizza DinnersTuition includes one pizza dinner (Sunday, June 9). Please choose the number of pizza dinners you wish to add.One Additional Pizza DinnerTwo Additional Pizza DinnersThree Additional Pizza DinnersFour Additional Pizza DinnersFive Additional Pizza DinnersAdditional T-ShirtsTuition includes one t-shirt. Please choose the number of t-shirts you wish to add.One Additional T-ShirtTwo Additional T-ShirtsThree Additional T-ShirtsFour Additional T-ShirtsFive Additional T-ShirtsAdditional T-shirt SizesPlease indicate your additional t-shirt size(s)Early Bird Discount (if registered and paid in full by April 1) Early Bird Discount 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/ PhoneThis field is for validation purposes and should be left unchanged.