Non-Member Registration - Suzuki Music Association of Indonesia

2015 Suzuki Institute of Indonesia (SII2015)
Monday – Friday, June 29 – July 3, 2015
SPH International School, Lippo Karawaci, Indonesia
Non - SMAI Member Registration Form
May 11, 2015 EARLY REGISTRATION CLOSES
June 6. 2015 LATE REGISTRATION CLOSES
Please fill in all information using BLOCK LETTERS
Student’s name on Name Badge ____________________________________________________________
Student’s name on Certificate ______________________________________________________________
Instrument _______________ Date of Birth __________________ Student’s Age at Institute _________
Address ________________________________________________________________________________
City ___________________________ State _____________________________ Zip ________________
Phone (
) ____________________________ Cell Phone _____________________________________
Valid Email ______________________________________________________________________________
All communication before and during SII2015 from Committee will be done through email. Make sure you check your email regularly.
Current Piece ______________________________________________________________ Book _______
Polished Piece ______________________________________________________________ Book _______
Previous Orchestral Experience  Yes
 No
MusicReading Level  Pre-reader
 Beginner
 Intermediate
 Advanced
Name of Parent or Responsible Adult Attending Institute with Student
Mr / Mrs / Ms_____________________________________________________________________________
Relationship __________________________ Cell Phone _______________________________________
SII2015 FEES
Registration fee is non-refundable. Please tick your options below.
 Per Student Registration Fee before May 11
 USD 30 ____________
 Per Student Registration Fee after May 11
 USD 60 ____________
 New Beginners, Pre-Twinklers &Twinklers (Morning Session Only)
 USD 300 ___________
3 Sessions: Master Class, Group Lesson, And Music Activities
 Half Day (Suzuki Books 1-6)
 USD 350 ___________
3 Sessions: Master Class, Technique Group Lesson
And Orchestra (Book 1 Graduates and up) OR Musicianship Activities (Book 1 Students)
Schedule:Mornings for Pre Twinkles through Book 2 Afternoons for Book 2 Graduates and higher
 Full Day (Suzuki Books 1-6)
 USD 450 ___________
5 Sessions: Master Class, Technique Group Lesson,
Orchestra (Book 1 Graduates and up) OR Musicianship Activities (Book 1 Students),
Repertoire Class and +1 Extra Enrichment Class
Please Label 1, 2, 3 in order of preference
+1 Extra Enrichment Class:  Sport  Arts / Crafts  Musicianship  Yoga for Kids
Note: SII2015 will do its best to schedule your first preference. However this may not always be possible due to teacher schedules
and other factors. SII2015 may close enrichment classes if there is not enough participants.
 Advanced Program for Suzuki and Traditional students
 USD 550 ___________
5 Sessions: 30 minute Master Classes, Technique Group Class,
Performance Group Class, Chamber Music, Orchestra and Practice Time
 Extra Enrichment Classes
 Sport
 Arts / Crafts
 _____ x @ USD 75 / Class _____________
 Musicianship
 Lunch Box Program for 5 Days
 Yoga for Kids
 _____ x USD 30 / Person ______________
Dietary Requirements:_____________________________________________________________________________
 Additional Grand Concert Tickets
 _____ x USD 5 / Person ________________
Includes Reception after Concert
Participants receive 2 FREE tickets each: 1 for participant & 1 for 1 adult.
 Student Solo Recital FREE [FIRST COME FIRST SERVE!]
 Yes, Student is ready.
Recital Piece: ______________________________ Composer : ___________________ Duration: _____
Statement: My student has polished and memorized the recital piece listed above
Teacher Signature (required) ___________________________
Scholarship Donation (Thank You!)
TOTAL FEES:
Please Pay by Bank Transfer to:
Suzuki Music Association of Indonesia
BCA Kemang 1, Account No. 286 301 7564
Swift Code: CENAIDJA
Bank Address: BCA Kemang 1 Jl. Raya Kemang No 60 Jakarta Selatan 12060
Message: SII2015 + Participant’s Full Name
Registration is only completed after proof of transfer is received and registration form submitted.
My signature below signifies understanding and acceptance of the terms listed in the SII2015 program course.
Date
Name of childattending Institute
Signature of Parent/Guardian (required)
____________________________
_________________________________
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