Surname:

First Names:

Home Address:

Home Telephone Number:

School/College attended:

Age:

Date of Birth / /

Instrument:      

Voice   (Please tick box)

Lessons: County Council Music Service

Private: (Please tick box)

Name of Music teacher:

Last Associated Board Examination passed:

Name Any Other Ensemble/Choir you belong to:

Membership Applied For: (please tick box)

Parent/Guardian’s Signature:

Return the completed application form to

WWYM, The Wiltshire Music Centre, Ashley Road, Bradford - On - Avon, Wiltshire, BA15 1DZ.