| Name: |
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| Address: |
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| Telephone #: |
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| Email Address: |
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| Fax #: |
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| Date of Birth: |
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| Where did you hear about this workshop?: |
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| Knowledge of Theory: |
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| Music Reading Ability: |
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| Please choose up to three (3) clinics: |
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| Session I: |
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| Session II: |
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| Session III: |
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| Master Class with Bobby Brewer |
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| Evening Concert with Bobby Brewer: |
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