Intensive Training Workshop Registration Form & Questionnaire

Email Address*

Address Line 1*

Address Line 2

City*

State/Province/Region*

Zip/Postal Code*

Country*

Telephone*

Cellphone

Date of Birth* (MM/DD/YYYY)

Questionare

1) Nature of your involvement in music/professional: (please list title/employee/school/degrees)*

2) Number of years you have played the piano/organ/keyboard:*

3) Have you ever been injured from playing your instrument? If so, please describe the time and nature of the injury.*

4) Please describe briefly the type of technical training you have received thus far.*

5) Are there any medical, health or other pertinent factors which you believe should be brought to the instructors’ attention before participating in this workshop?*

6) How did you learn of this program?*

7) What specifically would you like to address during the training?*

8) Please list one or more links to video footage of your playing, if at all possible. Duration: 10 min. minimum. Videos may be uploaded online with the option of an unlisted (non-public) link, using YouTube, Vimeo, or other similar free video hosting sites.

The Lister-Sink Institute is not liable for injury at any time during the training program. Trainee is solely responsible for maintaining his/her own well-being through a prudent, mindful awareness of his or her physical limitations and abilities. Tuition payment is expected on the first day of training, unless otherwise agreed upon by the instructor. By signing my electronic signature to this form and clicking on the "Apply and Pay Application Fee" button, I agree to these terms.

Electronic Signature*

Electronic Signature of Parent or Guardian (If Applicable)