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When words leave off, music begins
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MusicA Braine l'Alleud
April 9-13, 2012
13th Edition
Application Form
Application Deadline: March, 1, 2012
download printable application form
to be sent to:
Mrs. Hilde Delle-Vigne
Fondation Bell'Arte
62, rue du Grand-Duc 1040
Bruxelles-Belgique
e-mail: ems.music.group.belgium@skynet.be
- O 2 ID pictures
!!! Please do not send your photos via e-mail.
Only hard copies are accepted!!! - O Biography
- O Active participant
- O Observer
- O Piano
- O 2 Pianos / 4 mains
- O Lyric art
- O Violin (Kati Sebestyen)
- O Violin (Nicole Engels)
- O Viola
- O Chamber music
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- Name:
_____________________________________
- Given name:
_____________________________________
- Sex:
_____________________________________
- Place and Date of Birth:
_____________________________________
- Nationality:
_____________________________________
- Address:
_____________________________________
_____________________________________
_____________________________________
- Phone:
_____________________________________
- e-mail:
_____________________________________
- Diplomas - Level:
_____________________________________
_____________________________________
_____________________________________
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Teachers:
_____________________________________
_____________________________________
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Current teacher:
_____________________________________
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Proposed works
1) _____________________________________
2) _____________________________________
3) _____________________________________
4) _____________________________________
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O Student of Braine l'Alleud Music School or ICPA
(Copy of student card must accompany this application)
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Accommodation
During the course my address will be
_____________________________________
_____________________________________
My Phone during the course
_____________________________________
I would like to apply for the Boarding School housing: YES - NO
(200 Euros from Monday morning till Saturday morning
For arrival on Sunday evening: + 7€ for breakfast)
- O Option for externs: Meals at noon: 35 Euros from Monday till Friday
Signature (by parents, if minor of age)
_____________________________________
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Payment Details:
Application fee: 75 Euros
tuition: _______________ Euros
housing: _______________ Euros
in case of international bank transfer: + 10,00 Euros
total amount: _______________Euros
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