Surname:

First Name:

Date of Birth:

Home Address:

Postcode:

School or Occupation:

Daytime Contact number:

Home Telephone Number

ParentsGuardians name (if under 18):

Please give details of Musical Experience (if any):

Please state which instrument you are interested in learning:

'Cello Clarinet Cornet Drumming Flute French Horn Guitar (Acoustic) Guitar (Classical) Guitar (Eletric) Oboe Piano Recorder Saxophone Theory (Private) Trombone Trumpet Tuba Viola Violin Voice (Classical) Voice (Theatre) Voice (Pop)

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I accept the regulations of the Ulster College of music and agree to be bound by them