AGE:_____________________________________________________
STREET
ADDRESS:__________________________________________
CITY:____________________________________________________
STATE:__________________________ZIP:_____________
COUNTY OF RESIDENCE:______________________________________
E-MAIL ADDRESS:____________________________________________
PHONE NUMBER:___________________________________
NAME
OF COMPOSITION:_______________________________________
INSTRUMENT:________________________________________________
TEACHER'S NAME:____________________________________________
TEACHER'S
STREET:_____________________________________________________
STATE:__________________________ZIP:________________________
PHONE NUMBER:_______________________________________________
TEACHER'S
E-MAIL ADDRESS:___________________________________
TEACHER'S SIGNATURE:_________________________________________
Applications must include $25 non-refundable entry fee and must be postmarked by April 3, 2009. Send form to:Karen Bessey
105 Shannon Court
Rocky Mount, North Carolina 27804