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Musica Mundi - Application form 2019

Sex
I also play the viola (for violinist) ?
Parents or guardians are required to fill in the following authorisation:
Hereby authorize:
To take part in the Musica Mundi Summer course and festival. 

Print this completed form and send a PDF by e-mail together with your parent's signature (if under 18)

MUSICA MUNDI ASBL

 

Monsieur Leonid Kerbel - Mme Hagit Hassid-Kerbel

21, avenue des Marnières - 1410 Waterloo - Belgique
Tél.: +32-(0)-2-6520101 - Fax: +32-(0)-2-6540362
GSM: +32-(0)-495-223229 - +32-(0)-495-200595
e-mail : info@musicamundi.org

Musica Mundi ASBL
Compte IBAN = BE 50 1925 1921 9218 - Code BIC/SWIFT= CREG BE BB
Address : CBC Banque Waterloo Office Park - Dréve Richelle 159 - 1410 Waterloo, Belgium
N° de T.V.A. : BE 0461.039.713

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