Application Form

Musica Mundi - Application form 2019

First Name

Surname

Date of birth

Sex

Nationality

Address

Post Code

City

Country

Instrument

Phone

Number of years studied

E-mail

I also play the viola (for violinist) ?

Yes

Teachers and schools (mention all the teachers you studied with)

Chamber music experience

Mother tongue

I also speak

Parents or guardians are required to fill in the following authorisation:

I, the undersigned

Address

Post Code

City

Country

Phone number

e-mail

Relationship to participant

Hereby authorize:

name of the applicant

To take part in the Musica Mundi Summer course and festival.

Signature

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

Musica Mundi

INTERNATIONAL CHAMBER MUSIC COURSE & FESTIVAL

Since 1999

Musica Mundi - Application form 2019

Parents or guardians are required to fill in the following authorisation:

Hereby authorize:

To take part in the Musica Mundi Summer course and festival.

MUSICA MUNDI ASBL