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YSV 2013 Application Form

Registration Details For multiple sibling applications, complete payment details in full on one application form only.

Return this form to: Andrew Lucas, LDSM, Stricklandgate House, 92 Stricklandgate, Kendal, Cumbria LA9 4PU, UK

Early Bird Applications

students @ £220

Prior to 31 March 2013

students @ £200 (siblings)

Contact Information First Name

Surname

Date of Birth

Gender

Full Fee Applications Male

students @ £250

Female

students @ £230 (siblings)

£

Home Address T-shirts £9.50 each Please indicate amount required in each box

Postcode Home Phone

Mobile

Age 5-6

Age 7-8

Age 9-10

Small

Small

Medium

Large

mens

womens

unisex

unisex

£

Grand Total

£

Email Address Parent/ Guardian Name

Payment Method A) I enclose a cheque made payable to ‘LDSM’

Musical Experience

B) Please debit my

Principal Instrument

Start Date

Date

Visa

Visa Debit

Maestro

To the amount of £.......................... (print clearly)

Previous examinations on main Instrument Board

Mastercard

Card No.

Grade

Mark Issue date

Expiry date

No. Security No. (last 3 digits on signature strip) Issue (Maestro only)

Anticipated date and grade of next exam

Name on Card.............................................................................................................

Any other instruments and approximate grade

Cardholder’s Signature...............................................................................................

Teacher Reference Please ask your teacher to complete a brief reference indicating child’s skill on their principal instrument, including information on position work, bowing, sight reading ability & ensemble experience. Include with this application or email (with full name of student) to courses@ldsm.org.uk Teacher’s name Teacher’s Email Teacher’s Contact No. Please indicate if the teacher would like to be sent information on future courses for their students Yes No

How did you hear about LDSM? (please tick) Advert

Online Advert

Internet Search

Listing

Leaflet

Poster

School/Music Centre (name of school/centre........................................................................................) Training Institution (name of institution.............................................................................................................) Recommendation of Tutor (name of tutor.......................................................................................................) Recommendation by Previous Attendee (name of attendee.....................................................................) I came in a previous year (please state.................................................................................................)

ysv_2013_application_form  
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