PIANO PLUS! APPLICATION

Teacher's Information

Teacher must be an active member of the PTC

Teacher's First Name

This field is required.

Teacher's Last Name

This field is required.

Teacher's Email

This field is required.

Teacher's Phone Number

This field is required.

Performer's Information

Performer's First Name (1)

This field is required.

Performer's Last Name (1)

This field is required.

Performer's age (1)

This field is required.

Performer's Instrument (1)

This field is required.

Teacher's First Name (1)

This field is required.

Teacher's Last Name (1)

This field is required.

Performer's First Name (2)

This field is required.

Performer's Last Name (2)

This field is required.

Performer's age (2)

This field is required.

Performer's Instrument (2)

This field is required.

Teacher's First Name (2)

This field is required.

Teacher's Last Name (2)

This field is required.

Performer's First Name (3)

This field is required.

Performer's Last Name (3)

This field is required.

Performer's age (3)

This field is required.

Performer's Instrument (3)

This field is required.

Teacher's First Name (3)

This field is required.

Teacher's Last Name (3)

This field is required.

Additional Performers

Are You Playing a Concerto with Your Teacher?

Yes

Additional Notes

Program

Composition (1)

This field is required.

Composer (1)

This field is required.

Composer Date (1)

This field is required.

Composition (2)

This field is required.

Composer (2)

This field is required.

Composer Date (2)

This field is required.

Total Timing

Application Fee:

PayPal

PayPal selected for checkout

*A non-refundable processing fee of 2.2%+$0.30 will be added to the final amount*
Please Note: The application fee is non-refundable after the application due date.