Benefit Recital Application
Third Annual Christopher Widjaja Memorial Concert to Benefit Myocarditis Foundation will take place on Saturday, May 12, 2018 at 4 PM at
St. Mary Armenian Church
200 West Mt. Pleasant Ave
Livingston, NJ 070392.
A short talk on children's myocarditis, its signs and prevention, will be delivered by a cardiologist.
Refreshment will be served; courtesy of Widjaja family.
Piano accompaniment at the concert and two rehearsals will be provided; courtesy of the Do-Re-Mi School. Piano score has to be submitted before 4/22.
All proceeds will benefit education and research on Myocarditis.
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Student's Name (First/Last) -1 *
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Student's DOB *
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Student's Name (2)
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Student's DOB (2)
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Student's Name (3)
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Student's DOB (3)
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Parent's Name(s) *
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Phone Number *
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Alternative Phone Number
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Instrument *
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Piece title *
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Composer *
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Piece length *
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Is the piece memorized? (memorization required) *
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Do you need an accompanist? *
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Photo/Video *
Payment: $30 per participant, includes 2 tickets (performer doesn't need a ticket). Each additional ticket is $15
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