Thank you for you interest in the Music From China Youth Orchestra. Please complete the form below to register. If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required First Name * Last Name * Chinese Name DOB Mailing address City State -- select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire Croatia (Local Name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Timor-Leste (East Timor) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia, South Sandwich Islands South Sudan Spain Sri Lanka St. Helena St. Pierre And Miquelon Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic Of Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Telephone * Email * Instrument: ErhuLiuqinYangqinZhengRuanPercussionDiziCello Instrument - other: I have studied the Chinese instrument(s): Number of years studying instrument Please check one of the following to enroll in the Music From China Youth Orchestra. * 2015-2016 Season - Orchestra fee: $550, 24 x 2-hour rehearsals (annual concert at Drew University in 2016)2015 Fall Session only (Sept. – Dec.) - Orchestra fee: $315, 12 x 2-hour rehearsals2016 Spring Session only (Feb. – June) - Orchestra fee: $315, 12 x 2-hour rehearsals (audition required for new members to attend annual concert) Registration fee: $25 (FREE REGISTRATION BEFORE AUG. 25, 2014) Send payment by check or money order payable to Music From China Address: Music From China, 170 Park Row, #12D, New York, NY 10038 Total enclosed: $ Check #: Emergency Information Emergency phone number is the phone number, cell phone number, or beeper number where you can be reached during class hours. Mother’s Name Mother's Phone Father’s Name Father's Phone Emergency contact (if parent not available) - Name: Emergency contact's Phone WAIVER I/We, as parent(s) or legal guardian(s), hereby agree to the following terms of agreement regarding the participation of my/our child in activities sponsored by Music From China, a non-profit organization: (1) The said organization of its officials, teachers, volunteers, or employees will not be responsible or liable for any and all claims, injuries, accidents, damages or loss incurred to my/our child, other family members and property in said activities or any part of its education program. (2) The said organization may be permitted to reproduce images of my child in print through his/her participation in the above sponsored activities and for the sole purpose of future promotion of said activities. Waiver Confirmation * AgreeDo not Agree *