Mediant Studies: Intermediate Theory Registration Form

Music Courses
Outline of the Intermediate Theory Course | Intermediate Theory Registration Form

INTERMEDIATE THEORY REGISTRATION FORM

Mr/Mrs/Miss/Ms ............................................. Phone: ...........................................
Address: .................................................................................................................
................................................................................. Fax: ........................................
Email Address : .......................................................................................................

Here is a breakdown of fees.

Intermediate Theory Course	120.00
Postage (including marked scripts)	$10 within NZ $20 overseas
Registration fee	10.00
Total payable	140.00

If paying from other countries, please add a bank fee of $15. In some circumstances, the bank will accept personal cheques, so a lower fee is charged. This should be discussed with the director

Please fill out this form, and post it, enclosing a cheque for $140, made out to Mediant Studies, to Private Box 56132, Dominion Rd, Auckland 1446.

Please indicate if you have passed any school, university or grade music theory exams:
................................................................................................................................

My main instrument (or voice) is: ................................................................................

Cross out what does not apply:
I want / I do not want / I am not sure whether to sit the examination.

If you are intending to sit an examination at the end of the course, please indicate which examination it is:
Royal / Trinity / ................................ Grade ........... School: year ...................

I have read and understood the regulations.
Signature: ............................................. Date: ....... / ..... / ........

Where students are of school age, parents are asked to append their signature:
Signature: ............................................. Date: ....... / ..... / ........