Interest Form for Lawrence University StudentsThank you for interest in the Community Music School! Please fill out the form below if you are a Lawrence University student. Interested In I would like information about * Music Lesson Registration Conservatory/Community Music School Student Mentorship Creating an Community Music School program (meet with Community Music School director) I am a current * - Select -Conservatory studentCommunity Music School student Studio Teacher Name * Instrument/Voice * - Select -ViolinViolaCelloString BassPianoPercussionFluteClarinetOboeBassoonSaxophoneFrench HornTrumpetTromboneTubaGuitarHarpVoiceOtherIf other, please put the name of your instrument in the Comments section of the form. Level of Experience * - Select -BeginnerIntermediateAdvanced Student Information First and Last Name * Gender * Female Male Birthdate * Year192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Campus Address * Email Address * Your Lawrence email address will the the address that the Community Music School will send messages to. To ensure delivery of these messages, please add cms@lawrence.edu to your email contact list. Verify Email Address * Preferred Phone Number * Format ex. 9205551212 Home Cell Home or Cell * How did you hear about Lawrence Community Music School? * Comments CAPTCHA This question is included to prevent automated spam submissions; it is not presented to logged-in users. Submit
