Musicale Registration Musicale Date*SeptemberOctoberNovemberDecemberJanuaryFebruaryMarchStudent Name* First Last Parent's Name* First Last Parent's Cell Phone #*Parent Email* Enter Email Confirm Email Teacher Name*Teacher's Email Address*Teacher's Cell Phone #*My teacher is a current STXSA Teacher Member (required for participation)* Yes No Student Age*Instrument*Student's Suzuki Book Number*Title of Piece to be Performed (ie. Musette)*Composer of Piece (ie. J.S. Bach)*Performance Time of Piece in Minutes (ie. 1.5)*This is a* Solo Ensemble If this is an ensemble, please enter ensemble type (quartet, trio, etc.) and additional performer information here (names, ages, instruments)Accompanist* I have my own accompanist who will play for me at the musicale My teacher or parent will be accompanying me with a duet part I will rehearse and perform with the STXSA accompanist (only valid if one is provided for this particular musicale) My piece is originally written to be unaccompanied and does not require accompaniment I am a guitarist, pianist, or harpist and my piece does not require accompaniment This is an ensemble and does not require accompaniment Accompanist name and instrumentTeacher Approval* Student's piece is memorized and has been approved for performance by the student's teacher. (memorization not required for ensembles)I am a STXSA FAMILY MEMBER* Yes - STXSA FAMILY MEMBER ($25) No - NON-MEMBER ($40) I would like to volunteer on the day of the event. Please contact me about volunteering (volunteers needed to help with the reception, set-up, clean-up, bring beverages, paper goods, photography, accompanying, etc. I would like to support STXSA with a donation to the STXSA General Fund (please enter your desired donation dollar amount)Total $0.00 Payment MethodPayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name STXSA Photo and Liability ReleaseBy submitting this form the undersigned, on behalf of himself or herself and the participant (if a minor) hereby releases and discharges STXSA and its officers, employees, agents and assigns (referred to herein as "STXSA") of and from all claims, liabilities, and causes of action for damages and injuries including those caused by any act or failure to act, negligence, willful misconduct, breach of contract, product liability or violation of statute arising from or relating to the undersigned and/or the participants' attendance and participation in the event described above. I agree to indemnify STXSA and hold it harmless from all such losses, liabilities, damages, claims and actions including legal fees and fees of defense arising out of this event (workshop/class/concert/play-in/etc.). The undersigned, further consents, on behalf of himself or herself and the participant (if a minor), to STXSA's use of photos, videos or recordings of the undersigned and/or the participant from this event (workshop/class/concert/play-in/etc.) for publicity for the organization in print or electronic media. Δ