Pacific Piano Day Registration and Payment Form

Proficiency requirement: Certificate of Merit Level 8 or above.

Repertoire: prepare one piece (memorization preferred).

Registration fees:
- $50 Participant
- $25 Observer (attend, but do not perform)
- $15 Piano teacher

Observers and teachers will have the option of joining in person or via Zoom.

Deadline to register: March 18, 2022.

Personal Information

First Name

Last Name

Email Address

Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

School Information

[Leave blank if not applicable]

Enter your high school or school district if homeschooled

Graduation year

Enter the name of your private teacher

Enter the email address for your private teacher

Music selection

[Leave blank if not applicable]

Name of piece

Composer

Material Use Authorization

By checking this box yes, I hereby grant permission and the rights to use my son/daughter's image, likeness and sound of his/her voice, and any specific quotes, as recorded on audio, video or camera, either digitally or on tape/film ("Material") to University of the Pacific, without payment or any other consideration. I understand that the Material may be edited, copied, exhibited, published, or distributed and I waive the right to inspect or approve the finished product wherein the Material appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the Material. I also understand that this Material may be used in diverse settings within an unrestricted geographic area.

Yes

Type of Participant

Please select what type of registrant you are

Participant

Observer

Teacher

I will join by:

Zoom

in person