MusicIN Student Registration Form

Today's Date * +

Student Name *

Instrument *

Parent E-Mail Address *

Additional E-Mail Address (optional)

Student/Parent Phone Number *

Mailing Address for Certificate Delivery (USA addresses only) 🛈

City

State

Zip Code

Teacher Name *

Is teacher an MTNA member? *

MTNA Member

Non-MTNA Member (+$30)

Teacher MTNA Number *

Teacher E-Mail Address *

Are you signing up for Evaluations or Artist Competition? *

Evaluations

Artist Competition

Are you signing up for a Virtual or In-Person Evaluation? *

In-Person (San Jose, CA)

Virtual (open to California and beyond!)

Do you have a preference of AM or PM (Pacific Time) for the Live Evaluation? *

AM

PM

Flexible

Evaluations Level *

Artist Competition Category *

Fees:

$0.00

There are no refunds once paid.

Media Waiver: By checking YES, you acknowledge that you have read and agree to these Terms and Conditions. By checking YES, you also acknowledge that you are 1) age 18 or older or 2) the parent or legal guardian of the applicant under age 18. I hereby grant my consent to the California Association of Professional Music Teachers, Santa Clara Valley Chapter (CAPMT SCV) to photograph, electronically record, transfer, or film the applicant for distribution in all media at any time, all public performances and appearances in or associated with CAPMT SCV events without any compensation or remuneration. I also grant to CAPMT SCV the right to use any such recorded performances, interviews, quotations or photographs of the applicant; and the right to use the applicant's name, voice, image, and likeness in connection with a CAPMT SCV event, including but not limited to: publication in books, magazines, pamphlets, advertising, and newspapers; and on television, radio, internet, and social media channels, without any compensation or remuneration.

Yes