American String Teachers Association with NSOA
Certificate
Program for Strings
2004 Florida Application Form
Application
deadline: May 1st 2004, postmark
Exam Location: Gainesville_____Miami_____Tallahassee_____WestPalmBeach_____
Instrument___________________________________Level_______________________
Name of Student __________________________________ Grade_____ Age ________
Address_________________________________________________________________
___________________________________________ Phone_________________
Accompanist’s name(if used)_______________________ Phone_________________
Works to be performed:
Teacher’s Name
________________________________ Phone __________________
Teacher’s
Address_________________________________________________________
Teacher's preferred time to help as
monitor or as needed__________________________
Enter special student scheduling requests
here:______________________________________
The signatures below show that we
understand the rules governing this event and agree to abide by them:
Teacher’s signature: _________________________Parent
Signature:____________________
Please duplicate applications as needed.
Teacher
membership in the state chapter of ASTA is required. To join ASTA or to make
special arrangements contact the certificate program coordinator below.
Make check payable to: Florida ASTA w/
NSOA and send to:
Patrick
Clifford
PMB
247
222
Lakeview Drive Suite 160
West
Palm Beach, Florida 33401