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Green Mountain Suzuki Institute Online Registration Form

Please fill in all relevant information in the form below.

Before you register, you will need to gather the following information:

• your child's teacher's phone number
• your child's current Suzuki volume
• your child's current Suzuki piece
• if your child reads music, the composer and name of his/her most recent reading piece
• if your child is signing up for chamber music or piano duets, the composer and name of his/her most recent ensemble piece

Please note that we are not able to accept payment on-line at this time.

Your registration is not complete until you mail your registration deposit check of at least $100 per student.

Checks should be made out to Green Mountain Suzuki Institute and mailed to:

Green Mountain Suzuki Institute
400 Dog Team Road
New Haven, VT 05472

Final payments are due no later than June 1, 2010.

PLEASE NOTE: we have an enrollment limit for each of our instruments. Submission of this form does not guarantee a place in the program. Your check will be returned if we receive it after we reach our maximum enrollment.

= = = = Please fill out one registration form per child = = = = + Indicates a Required Field
	Parent Information
+ Parent First Name
+ Parent Last Name
+ Street Address Line 1
Street Address Line 2
+ City
+ State or Province, Country	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Quebec Saskatchewan Yukon Argentina Bahamas Belize Bermuda Bolivia Brazil Chile Colombia Costa Rica Dominican Republic Ecuador El Salvador Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Puerto Rico Uruguay Venezuela Australia Austria Barbados Belgium China Denmark England Finland France Germany Ghana Greece Grenada Holland Iceland India Indonesia Ireland Israel Italy Japan Kenya Korea Malaysia Martinique New Zealand Norway Philippines Poland Portugal Russia Saudi Arabia Scotland Serbia and Montenegro Singapore Slovenia South Africa Spain Sweden Switzerland Taiwan Tanzania Thailand Tunisia Turkey Zimbabwe
+ Zip or Postal Code
+ E-mail
Day Phone (xxx) xxx-xxxx
+ Evening Phone (xxx) xxx-xxxx
+ Preferred method of communication	e-mail US mail
Name of Adult Accompanying Student if Other Than Above
	Student Information
+ Student First Name (as it should appear on name tag)
+ Student Last Name
+ Date of Birth	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
+ Age on July 1, 2010	4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
+ Gender	Female Male
+ GMSI Program	Suzuki Instrument Program Non-Suzuki Instrument Program Non-Instrument Sibling Program
+ Fill in the following if your child will be in an instrument program
Primary Instrument	Piano Violin Viola Cello Flute
Current Suzuki Volume	Volume 1 Volume 2 Volume 3 Volume 4 Volume 5 Volume 6 Volume 7 Volume 8 Volume 9 Volume 10
Current Suzuki Piece
If your child reads music, please list her/his current reading piece
Teacher's Name
Teacher's Phone

Elective Choices We will do our best to honor your choices for all electives.
Instrument Electives: Please select the instrument electives your child would like to participate in. * Indicates additional fee.
	Chamber Music *	no yes
	If yes, has your child had any ensemble experience?	no yes
	Please list your child's most recent ensemble piece, including composer and title.
	Piano for 4 Hands *	no yes
	Orchestra I (Strings Suzuki Vols. 1 and 2, some music reading required)	no yes
	Orchestra II (Strings Suzuki Vols. 3 and 4)	no yes
	Viola for Violinists (Suzuki Vols. 4 and up)	no yes
	Fiddling (for strings, late Vol. 1 and up)	no yes
	Second Instrument Lessons *	no yes
	Which instrument? Piano Violin Viola Cello Flute Current Suzuki Volume? Volume 1 Volume 2 Volume 3 Volume 4 Volume 5 Volume 6 Volume 7 Volume 8 Volume 9 Volume 10 Current Piece Teacher's Name Teacher's Phone
Other Electives: Please rank at least 5 electives, with "1" being the elective your child would like the most. We will do our best to schedule your child for his/her top choices.
	Singing Games (Ages 4-8) 0 1 2 3 4 5 6 International Folk Dancing 0 1 2 3 4 5 6 Hand Bells (Ages 8 and up) 0 1 2 3 4 5 6 Theater Games 0 1 2 3 4 5 6 Art 0 1 2 3 4 5 6 Yoga 0 1 2 3 4 5 6 Taiko Drumming 0 1 2 3 4 5 6 Composition (Ages 8 and up) 0 1 2 3 4 5 6

Would your child like to perform a solo in a mini-recital during the Institute?

no yes

Participant T-Shirt

Each registered child at GMSI will receive a free cotton Green Mountain Suzuki Institute 2009 T-shirt. Please specify the size. Youth XS (2-4) Youth S (6-8) Youth M (10-12) Youth L (14-16) Adult S Adult M Adult L Adult XL

Additional T-Shirts
You may purchase additional T-shirts in advance only for $15 per shirt. Payment must be included with your deposit. Please indicate how many of each size you would like:
0 1 2 3 4 5 Youth XS (2-4)	0 1 2 3 4 5 Adult S
0 1 2 3 4 5 Youth S (6-8)	0 1 2 3 4 5 Adult M
0 1 2 3 4 5 Youth M (10-12)	0 1 2 3 4 5 Adult L
0 1 2 3 4 5 Youth L (14-16)	0 1 2 3 4 5 Adult XL
	0 1 2 3 4 5 Adult 2XL

Fee Schedule and Payment
Tuition if First Student in the Family	$425	$0 $425
Tuition if Second Student in the Family	$375	$0 $375
Tuition if Non-Instrument Sibling	$175	$0 $175
Chamber Music Elective	$100	$0 $100
Second Instrument Lesson Elective	$100	$0 $100
Piano 4 Hands Elective	$65	$0 $65
Additional T-Shirts	@$15	$0 $15 $30 $45 $60 $75
+ TOTAL FEES (excluding scholarship)	$
If you are requesting an automatic $75 tuition scholarship, check here. (Note: the $75 scholarship may not be applied to Non-Instrument Sibling Tuition.)

Would you like to make a tax deductible contribution to the Green Mountain Suzuki Institute?
Yes, I will include a donation with my registration deposit check.	$0 $10 $25 $50 $75 $100 $250 $375 $500 $750 $1000 $2000
You may recognize me as a supporter of the GMSI in your printed program materials.	no yes

Comments, questions, special instructions? Please enter them here:

info@greenmountainsuzukiinstitute.org
400 Dog Team Road | New Haven, Vermont 05472 | 802-453-2360
The Green Mountain Suzuki Institute is an educational program of by the Rochester Chamber Music Society, a 501(c)3 organization.
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PHOTO CREDITS: Kristina MacKulin, John Robbins, and Betsy Homa.
All images are copyright 2009 and 2010, Green Mountain Suzuki Institute, and may not be used without written permission.