Name *

First Name

Last Name

Phone *

Country

(###)

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Name of Instructor

Not required for Adult Amateurs and Professionals

First Name

Last Name

Name of Collaborative Pianist

Only required for performers who wish to provide their own collaborative pianist

First Name

Last Name

Validation *

By checking this box, I am confirming that the above information is truthful, and hereby authorize Progressive Musicians to publish all program information (including repertoire, performers' names, ages, and head shots) for print in programs and advertisements of this event.

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