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MTSU Jazz Festival Student Registration
(Complete and "Send" at the bottom of the form.)


Personal Information :
Name - Last First Middle Initial
E-mail address
Area Code ( ) Phone
Instrument:
Name of School:
Grade in School:
Are you a member of the Murfreesboro Youth Jazz Orchestra? Yes No


Mailing Address:

City State zip

EMERGENCY CONTACT:
Name:
EMERGENCY PHONE 1: Area Code ( ) Phone
EMERGENCY Phone 2: Area Code ( ) Phone

BAND DIRECTOR'S INFO:
Band Director's name:
Band Director's e-mail:
Do you participate in your school jazz ensemble? YES NO