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 * Year192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008 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
