Musician's name

Select primary instrument... Vocals Electric guitar Acoustic guitar with pickup Electric bass Double bass with pickup Drums Percussion Keyboard Alto saxophone Tenor saxophone Baritone saxophone Soprano saxophone Clarinet Flute Trumpet Trombone Electric violin Electric cello Turntables/samplers Other
Primary instrument

Select number of years played... Less than one One Two Three Four Five Six Seven Eight Nine Ten More than ten
Primary Instrument Years played

Select secondary instrument... Vocals Electric guitar Acoustic guitar with pickup Electric bass Double bass with pickup Drums Percussion Keyboard Alto saxophone Tenor saxophone Baritone saxophone Soprano saxophone Clarinet Flute Trumpet Trombone Electric violin Electric cello Turntables/samplers Other
Other/secondary instrument

Select number of years played... Less than one One Two Three Four Five Six Seven Eight Nine Ten More than ten
Secondary Instrument Years played

Have you taken private lessons? Yes No

Teacher's Name

Do you sing? No Yes-lead and backup Yes- only backup

Have you ever played in a a band? Yes No

Can you read music? Yes No

Can you improvise? Yes No

List some of your favorite bands

List other musicians you want to play with

Street address

Apartment number

City/town

Select state... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
State (United States only)

Zip code

Home phone

Work phone

Cell phone

Email address

How did you hear about us? How did you hear about us? Word of mouth Saw a brochure somewhere On the internet

Additional comments

Please make checks payable to Harcum College and mail payment fees to:

Summer Music Programs
Harcum College
Bryn Mawr, PA 19010