test APSEF Autumn Piano School enrolment Step 1 of 6 16% Student's Name(Required) First Last Student's Email(Required) Student's Phone(Required)Residential Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Gender(Required) Female Male Other Date of Birth(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 How long have you been playing the piano? (years)(Required)Do you teach music?(Required) Yes No Are you a studio teacher or a classroom music teacher? (select all that apply) Studio piano teacher Classroom teacher Studio teacher (not piano) How many years have you been teaching?In which age groups do you specialise? 3-4 years 5-7 years 7-12 years 13-18 years 18+ pre-tertiary/tertiary Adult amateurs What is the highest level to which you teach (AMEB or equivalent)? Beginner Prelim to Grade 4 Grades 5 to 7 Grade 8 and Diploma Are you currently having piano lessons?(Required) Yes No Who is your piano teacher? What standard of repertoire are you playing (AMEB or equivalent)?(Required) Beginner Preliminary to Grade 4 Grade 5 to 7 Grade 8+ Have you completed a formal piano exam? Yes No Which examination board? AMEB ABRSM Trinity ANZCA St Cecilia Other Will you be enrolled in Year 11/12 Music in 2024? Yes No Are you considering a career in Music? Yes No Will you be enrolled in Music at university level in 2024? Yes No Which university? Which degree? Which year of study?Do you use any of the following piano method books? Alfred’s Piano Course Faber Piano Adventures Piano Safari Yamaha Piano Course Suzuki Piano Method Bastien Piano Basics Other (name) Which piano books do you use? If you are a parent or caregiver, would you like to observe the lessons and master classes? Yes No Would you like to have one-to-one lessons and/or participate in a performance workshop? One-to-one lession Performance workshop What are you looking forward to doing at this school? EnrolmentDisability & leaning difficulties – please tell us anything we should knowIndigenous Status - Is the student of Aboriginal or Torres Strait Island descent?(Required) Yes No Is a language other than English spoken at home?(Required) Yes No If yes, what language? Please indicate any allergies or medical/behavioural conditions Parent/Caregiver (if applicable)Additional Parent Name First Last Additional Parent PhoneAdditional Parent Email Emergency ContactEmergency Contact Name(Required) First Last Emergency Contact Phone(Required) StreamIn which stream do you want to enrol?(Required) Pedagogy full day $700 Pedagogy half day $400 Beginner $250 Junior $300 Intermediate $500 Advanced $700 Adult Amateur $700 What repertoire would you like to present?(Required)Please include composer, title and any other relevant information (e.g. opus number, movement, key)Recital TicketsYour enrolment gives you 15% family and friends discount to all recital ticket (limit of 10 per recital). Seating will be assigned based on availability. Seating is General Admission. Available at time of enrolment only.ADULT Tickets (15% off) for Thursday 18 April 7.30pm: Konstantin Shamray Quantity Price: $ 42.50 Quantity CONCESSION Tickets (15% off) for Thursday 18 April 7.30pm: Konstantin Shamray Quantity Price: $ 34.00 Quantity ADULT Tickets (15% off) for Friday 19 April 7.30pm: Bernadette Harvey Quantity Price: $ 42.50 Quantity CONCESSION Tickets (15% off) for Friday 19 April 7.30pm: Bernadette Harvey Quantity Price: $ 34.00 Quantity ADULT Tickets (15% off) for Saturday 20 April 7.30pm Quantity Price: $ 42.50 Quantity CONCESSION Tickets (15% off) for Saturday 20 April 7.30pm Quantity Price: $ 34.00 Quantity Autumn Piano School Enrolment Terms & Conditions*Enrolment Terms & Conditions(Required) I have read and will uphold the Enrolment Terms & ConditionsMedia Release(Required) I DO give permission for Piano+ and the New England Conservatorium of Music (NECOM) to obtain and publish content that may include me/my child’s image and/or name for communications, promotional & archival purposes. Communications include but are not limited to, print media, television and video, radio, and publicly available websites and Piano+ and NECOM social media sites. Content includes but is not limited to photographs, text, illustrations and graphics, videos, sound recordings and examples of participants work. I DO NOT give permission for Piano+ and NECOM to obtain and publish content that may include me / my child’s image and/or name for communication, promotional & archival purposes. Communications include but are not limited to, print media, television and video, radio, and publicly available websites and NECOM social media sites. Content includes but is not limited to photographs, text, illustrations and graphics, videos, sound recordings and examples of participant works. Booking Fee(Required) Price: Total Credit Card(Required) American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name