Clinic Details Form

Contact Name Contact Name First Last
Contact Email
Name of Travel Company
Name of School
School Address School Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Date of Clinic Date of Clinic / MM / DD YYYY
Clinic Start Time Clinic Start Time : HH MM AM/PM
Length
Type of Ensemble(s
Venue(s) Check all that apply

Venue(s) Check all that apply Choral Hall Instrumental Rehearsal Hall (IRH) Turner Hall Ingram Hall Other classroom
If you have multiple ensembles meeting at different times & venues, please clarify here:
Number of Students
Are the students under the age of 18?

Are the students under the age of 18? Yes No
Will you be arriving in a bus?

Will you be arriving in a bus? Yes No
Who is your clinician?
Other
Additional Comments