EPIC BRASS SUMMER INSTITUTE REGISTRATION FORM
Schedule of EventsRegistration formPlacement auditions and important information
Phone Number (Required)
Medical Insurance Company and Policy Number
Physicians Name and Telephone Number
Emergency Contact and Relationship to Participant
Please Send a Finacial Aid Form (Deadline for filling March 1, 2008)
Please send me information about the AWS Summer Band
I hereby give permission for my child to receive medical treatment if cannot be reached
I agree to hold harmless Earl Raney, Epic Brass, Thayer Performing Arts Center, Atlantic Union College, Its Agents, employees,
contractors and volunteers from any and all claims sustained while participating in this program
Name (check if Parent or Guardian)
A Credit Card Number is required for the online Registration.
$50.00 Non-refundable registration fee must accompany each application. You may charge the entire $100.00 tuition.
Credit Card Number
Name Shown On Card
Charge Only $50 Dollar Deposit
Charge entire $100 to my Card
Do not email this form.
Mail or fax this form to:
Epic Brass Summer Institutec/o Earl Raney, Director146 Court Street Mansfield, MA 02048