MFB APPLICATION FORM
(Please type or print neatly in ink)


NAME (last, first, middle)


DATE OF BIRTH (day, month, year)


TELEPHONE (daytime)	TELEPHONE (evening, if different)


FAX NUMBER (if any)	E-MAIL ADDRESS (if any)


FULL MAILING ADDRESS


PERMANENT ADDRESS AND TELEPHONE NUMBER (if different from above)


Present Occupation	x Professional	x Student	x Non-professional


Name and Address of employer, school or music ensemble




Your principal instrument

For violin/viola/violoncello; Principal music teacher(s), years studied, and where



For Piano; Principal music teacher(s), years studied, and where



Recent Repertoire


Courses that interest you most at Music@ Felcino Bianco (circle one or more):

String Ensemble	Keyboard Ensemble	Cello Jazz

Instrumental Solo	Accompaniment	Improvisation

Strings players should bring their own music stands.
Music@ Felcino Bianco cannot be responsible for any loss of or damage to instruments.

Please indicate your preferred dates between 15th June - 20th August: 

Have you attended other music workshops before? 	x No	x Yes (please list)






Have you travelled to Italy?	x No	x Yes (list cities)



What languages do you speak?
(Teaching will be in English/Russian language)


Do you have health/travel insurance?	x No	x Yes
(Registration with Music@ Felcino Bianco does not include health coverage or insurance)


Applicant's Signature


Date of Application

If you are under 21 the name, address, telephone, and signature of parent or guardian is 
required.  Students under 18 may attend only with parental/family presence in support.







TO FILE YOUR APPLICATION, PLEASE ENCLOSE:

* Completed application form
* Resumé

Please send the application form for consideration prior to making a booking to:

Music@ Felcino Bianco
Felcino Bianco
Le Ville 79
52031, Anghiari (AR)
Toscana
Italia
+39 0575 70778
	
Please note:

The course fee is payable at the time of application. Cancellation fees apply:

* If you cancel before 15th May, we will deduct a booking fee of 50 euros from the refund.
* If you cancel between 15th May and 15th June, you will receive a 50% refund. 
* If you cancel after 15th June, there is no refund.
	
Payment may be made by cheque or by bank transfer in euros, US dollars, or sterling. Our bank details will be provided on request.