MusicA Braine l'Alleud
April 13-18, 2020

XX° Anniversary

• Name: ____________________________________________
  
  
• Given name: _______________________________________
  
  
• O ID picture
  by post mail or jpg file
  
  
• O Biography
  
  
  
• O Active participant
• O Observer
  
  
  
• O Piano
• O 2 Pianos / 4 mains
  
  
• O Chamber Music
  
  
• O Violin      O Yes, I need a pianist-je demande un pianiste (20 €)
  (piano scores, if pianist is requested, as pdf file with the application - at the course: hard copies, assembled, ready for use by the pianist!)
  
  
• Workshop: O Module A      O Module B (in addition to Module A only)
  
  
  
  

PERSONAL DATAS:


• Sex:
  
  _____________________________________
  
  
• Place and Date of Birth:
  
  _____________________________________
  
  
• Nationality:
  
  _____________________________________
  
  
• Address:
  
  _____________________________________
  
  _____________________________________
  
  _____________________________________
  
  
• Phone:
  
  _____________________________________
  
  
• e-mail:
  
  _____________________________________
  
  
• Diplomas - Level:
  
  _____________________________________
  
  _____________________________________
  
  _____________________________________
  
  
• Current studies:
  
  _____________________________________
  
  
• Current teacher:
  
  _____________________________________
  
  
• Former teachers:
  
  _____________________________________
  
  _____________________________________
  
  
• Proposed works
  
  
  1) _____________________________________
  
  2) _____________________________________
  
  3) _____________________________________
  
  4) _____________________________________
  
  
• O Student/inhabitant of Braine l'Alleud-Académie de Musique or ICPA
  (proof must accompany this application)

• Accommodation
  
  During the course my address will be
  
  _____________________________________
  
  _____________________________________
  
  My Phone during the course
  
  _____________________________________
  
  I would like to apply for the housing: YES - NO
  • The housing will be assigned by the organization, on an application roll base
  • The housing doesn't offer/include any meal.
  
  
• O Option : Lunch: 80 Euros from Monday till Friday
  
  The meals and housing have to be paid together with the application after confirmation of availibility, by the board.
  
  
  
  Signature (by parents, if minor of age)
  
  _____________________________________

• Cancellation before March 20, 2020: refund 50% of the tuition
• Cancellation before March 25, 2020: refund 25% of the tuition
• No refunding if cancelling after March 28, 2020
• The application fee is not refundable.