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Student's Name
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Student's Date of Birth
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Parent's Name (last name, then first)
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Student/parent's telephone number
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Student/parent's E mail address
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Teacher's Name (last name, then first)
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Teacher's Phone Number
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Teacher's E mail address
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MTAC Branch to which teacher belongs to
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Teacher's mailing address
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Student's number of years of piano study
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Student's CM level or equivalent
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Division I: age 10 & under
Division II: age 13 & under
Division III: age 18 & under, and pre-college
First piece to be performed - full title with opus number and key
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Duration of piece in min:sec
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Second Piece to be performed - full title with opus number and key
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Duration of piece in min:sec
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Third piece to be performed - full title with opus number and key
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Duration of piece in min:sec
Time
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Total duration in min:sec
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Please submit proof of age and check for fees, payable to MTAC-WLA to Competition co-chair Louisa Wong at 124 S. Kenter Ave., Los Angeles, CA 90049. Post mark deadline is January 19, 2018. Please refer to mtacwla.org for Competition guidelines and further details.
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