Date:		Social Security Number:		-		-

Name:
	(Last)	(First)	(MI)

Address:
	(Street)	(Apt #)	(City)	(State)	(Zip)

Home Phone:		( )

Name:		Home Phone:	( )

Address:
	(Street)	(Apt #)	(City)	(State)	(Zip)

Occupation:	Father:		Mother:

Name of High School:

Address:
	(Street)	(Apt #)	(City)	(State)	(Zip)

Name of Band Director:

Home Phone:	( )		School Phone:	( )

Major Instrument:		Secondary:

If Baritone Horn:	Trebel		or	Bass Clef
If Saxophone:	Alto		or	Tenor
If Percussion: Snare   Quards   Bass Drum   Cymbal

Do you own your Instrument?

( )

Yes

( )

No

Make of Instrument::

Number of years participated in Band?	Concert.		Marching.