2021 Chamber Music Workshop Registration Form
Registrant Information
First Name *
Last Name *
Email address *
Phone Number (cell) *
Phone Number (home)
Mailing Address *
Gender *
Date of Birth *
Participation *
Any Other Family Members Also Registering for the Workshop?
For Registrants Under 18
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone Number (cell)
Parent/Guardian Phone Number (other)
Parent/Guardian Email Address
Grade in School as of Fall 2020
School Name
Musical Background
Instrument *
Private Teacher Name *
Private Teacher Email Address
Years of Playing *
Current Repertoire *
Which of the Following Key Signatures Are You Comfortable Reading? *
Which of the Following Time Signatures Are You Comfortable Reading? *
Have You Ever Played in a Chamber Music Group Before? (If So, What Kind? e.g. String Quartet, Trio...etc) *
Do You Have Any Chamber Music Group Partner Request? *
If Yes, Who Are You Requesting?
Workshop & Registration Fee
By November 15, 2020
Fee: $200 for STEP students; $270 for non-STEP students

For non-STEP students - please mail a check made to "STEP Birmingham" to 3201 Lorna Rd, Birmingham, AL 35216
*Please note - your registration will not be complete without the check
STEP Birmingham Chamber Music Workshop Waiver
By typing my name below, I agree to the rules and regulations set by STEP Birmingham. I hereby consent and authorize STEP Birmingham to photograph and/or videotape my child, together with any subject matter owned by me, and authorize STEP Birmingham use such photographs, (including sound, motion pictures, and/or any other form of picture recording, radio, television, or print media) for all purposes which it deems proper in relation to STEP Birmingham.

I hereby voluntarily release, hold harmless and agree to indemnify STEP Birmingham in full, its agents, officers, employees, successors and assigns from any and all liability, claims, demands, actions, or rights of action, which are related to or are in any way connected with my child's participation in STEP Birmingham Chamber Music Workshop, including, but not limited to, any negligent act or omission of STEP Birmingham, its agents, officers or employees, successors and assigns, resulting in any and all injury to my child.

I understand that I am fully responsible for my child's instrument during the duration of the workshop. Any damage to the instrument, bow, case, or supplies other than normal wear and tear will be my financial responsibility up to the vault of the instrument. I understand that I am responsible for transporting my child to and from the workshop and for paying all workshop fee.
Signature *
Registration Video
All registrant must submit a video of a recent performance (home video taken with phone is OK) that best reflects the applicant's current level. Note that your registration is not complete without the video submission.

Please upload your video to a cloud service of your choice (e.g. Dropbox, YouTube, iCloud...etc), and provide your video link below. If you have questions about how to upload a video, please contact Laura Usiskin at lusiskin@gmail.com
Video Submission Link *
Comments, Questions, Concerns, Special Requests?
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