1177JadwinAve.,Suite103|Richland,WA99352|Tel:(509)9436602|midcolumbiasymphony.

org

2014/15 APPLICATION
All information must be filled out completely and legibly.
Please list your name as you would like it to appear in the concert programs. Send this form with your audition
fee of $25 to: Mid-Columbia Symphony, P.O. Box 606, Richland, WA 99352. We accept personal checks
only. NO CASH, PLEASE.

MEMBER INFORMATION
Members name: Instrument: Yrs. played:
Home Address: City: State Zip Code:
Home Phone: Cell Phone: E-mail:
Male Female Birth Date: Age (as of 9/1/14): Grade (as of 9/1/14):
Private Teacher: E-mail: Phone:
Flutists: Do you play piccolo? Yes No Oboists: Do you play English horn? Yes No

School you will attend September 2014:
Band or Orchestra Director:
Do you participate in a school ensemble? Yes No
MCYO members are required to participate in school band or orchestra where available. Students selecting No will need to submit
a School Participation Exemption Form signed by their director or private teacher where none is available.
Band Orchestra Other(s):

How did you first hear about MCYS? Band Teacher Orchestra Teacher Private Teacher
Other:

PARENT INFORMATION Please indicate the preferred primary parent contact: Father Mother
Fathers Name: Please circle one: Dr. Mr.
Home Address: City: State Zip Code:
Home Phone: Cell Phone: E-mail:
Fathers Employer: Work Phone:
Mothers Name: Please circle one: Dr. Mrs. Ms.
Home Address: City: State Zip Code:
Home Phone: Cell Phone: E-mail:
Mothers Employer: Work Phone: