Scholarship Competition 2019 Enrollment Form
Date: Saturday, February 2, 2019
Location: St. Cecilia Music Center

Junior High Division

Enrollment fee: $12

Enrollment forms and payment due: January PTF meeting or mailed by January 11 to: Cheri Verhey 948 72nd Street SE, Grand Rapids, MI 49508. Please send only one check payable to Piano Teachers' Forum of Grand Rapids.
Please complete one form for each student entered.

Note: Pieces must be played from memory. Original form, not arrangements, please.

Teacher FIRST then LAST Name *
As you would like it to appear in the program, Ex: Andrea Johnson
Your answer
# of registrations *
Teacher info is required for first entry only. For multiple entries, please proceed to Performer's info.
Your answer
Amount $ to be mailed in *
Teacher info is required for first entry only. For multiple entries, please proceed to Performer's info.
Your answer
Email *
Enter teacher's email here (Teacher info is required for first entry only. For multiple entries, please proceed to Performer's info.)
Your answer
Address
Enter teacher's complete street address here (Teacher info is required for first entry only. For multiple entries, please proceed to Performer's info.)
Your answer
City, State, and Zip Code
Enter complete mailing information here (Teacher info is required for first entry only. For multiple entries, please proceed to Performer's info.)
Your answer
Teacher Phone Number
(XXX) XXX-XXXX (Teacher info is required for first entry only. For multiple entries, please proceed to Performer's info.)
Your answer
Performer FIRST then LAST name *
Please note to enter FIRST then LAST name (Ex: Andrea Johnson)
Your answer
Grade *
Your answer
Student Address *
Enter student's complete address here
Your answer
City,State,Zip
Enter complete mailing information here
Your answer
Piece #1 Key
What key is THIS movement in?
Your answer
Piece #1 Title *
Your answer
Piece #1 Composer *
Your answer
Piece #1 Movt
Your answer
Piece #1 Opus
Your answer
Piece #1 No.
Your answer
Piece #1 HOB XVI
Your answer
Piece #1 SAT Level of Piece *
Your answer
Piece #1 Length (Minutes) *
Please use decimals (2.5 minutes)
Your answer
Piece #2 Key
What key is THIS movement in?
Your answer
Piece #2 Title *
Your answer
Piece #2 Composer *
Your answer
Piece #2 Movt
Your answer
Piece #2 Opus
Your answer
Piece #2 No.
Your answer
Piece #2 HOB XVI
Your answer
Piece #2 SAT Level of Piece *
Your answer
Piece #2 Length (Minutes) *
Please use decimals (2.5 minutes)
Your answer
Comments
Please include comments or concerns here
Your answer
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