Lakes Region Youth Orchestra

Lakes Region Youth Orchestra
Fall 2010 Registration
Member Detail

First Name, Last Name:
Nickame:
Address:
Town, State, Zip:
Home Phone:
Student e-mail:
Birthday:
Grade, School:

Ensemble Group:	__ Honors Strings __ Wind Ensemble __ Baroque Strings __ Concert Band __ Repertory Strings
Combined Group:	__ Philharmonic Orchestra __ Senior Orchestra

Primary Instrument:
Add'l Instrument(s):
School Music Teacher:
Private Music Teacher:

Mom's Name:
Mom's Work Phone, Ext:
Mom's Cell Phone:
Mom's e-mail

Dad's Name:
Dad's Work Phone, Ext:
Dad's Cell Phone:
Dad's e-mail

Insurance Carrier:
Medical Notes:
Emergency Contact:

Please print and return or paste into an e-mail and send to info@lryo.org

Personal Commitment to Musical Excellence