2015 Suzuki Institute of Indonesia (SII2015) Monday – Friday, June 29 – July 3, 2015 SPH International School, Lippo Karawaci, Indonesia Non - SMAI Member Registration Form May 11, 2015 EARLY REGISTRATION CLOSES June 6. 2015 LATE REGISTRATION CLOSES Please fill in all information using BLOCK LETTERS Student’s name on Name Badge ____________________________________________________________ Student’s name on Certificate ______________________________________________________________ Instrument _______________ Date of Birth __________________ Student’s Age at Institute _________ Address ________________________________________________________________________________ City ___________________________ State _____________________________ Zip ________________ Phone ( ) ____________________________ Cell Phone _____________________________________ Valid Email ______________________________________________________________________________ All communication before and during SII2015 from Committee will be done through email. Make sure you check your email regularly. Current Piece ______________________________________________________________ Book _______ Polished Piece ______________________________________________________________ Book _______ Previous Orchestral Experience  Yes  No MusicReading Level  Pre-reader  Beginner  Intermediate  Advanced Name of Parent or Responsible Adult Attending Institute with Student Mr / Mrs / Ms_____________________________________________________________________________ Relationship __________________________ Cell Phone _______________________________________ SII2015 FEES Registration fee is non-refundable. Please tick your options below.  Per Student Registration Fee before May 11  USD 30 ____________  Per Student Registration Fee after May 11  USD 60 ____________  New Beginners, Pre-Twinklers &Twinklers (Morning Session Only)  USD 300 ___________ 3 Sessions: Master Class, Group Lesson, And Music Activities  Half Day (Suzuki Books 1-6)  USD 350 ___________ 3 Sessions: Master Class, Technique Group Lesson And Orchestra (Book 1 Graduates and up) OR Musicianship Activities (Book 1 Students) Schedule:Mornings for Pre Twinkles through Book 2 Afternoons for Book 2 Graduates and higher  Full Day (Suzuki Books 1-6)  USD 450 ___________ 5 Sessions: Master Class, Technique Group Lesson, Orchestra (Book 1 Graduates and up) OR Musicianship Activities (Book 1 Students), Repertoire Class and +1 Extra Enrichment Class Please Label 1, 2, 3 in order of preference +1 Extra Enrichment Class:  Sport  Arts / Crafts  Musicianship  Yoga for Kids Note: SII2015 will do its best to schedule your first preference. However this may not always be possible due to teacher schedules and other factors. SII2015 may close enrichment classes if there is not enough participants.  Advanced Program for Suzuki and Traditional students  USD 550 ___________ 5 Sessions: 30 minute Master Classes, Technique Group Class, Performance Group Class, Chamber Music, Orchestra and Practice Time  Extra Enrichment Classes  Sport  Arts / Crafts  _____ x @ USD 75 / Class _____________  Musicianship  Lunch Box Program for 5 Days  Yoga for Kids  _____ x USD 30 / Person ______________ Dietary Requirements:_____________________________________________________________________________  Additional Grand Concert Tickets  _____ x USD 5 / Person ________________ Includes Reception after Concert Participants receive 2 FREE tickets each: 1 for participant & 1 for 1 adult.  Student Solo Recital FREE [FIRST COME FIRST SERVE!]  Yes, Student is ready. Recital Piece: ______________________________ Composer : ___________________ Duration: _____ Statement: My student has polished and memorized the recital piece listed above Teacher Signature (required) ___________________________ Scholarship Donation (Thank You!) TOTAL FEES: Please Pay by Bank Transfer to: Suzuki Music Association of Indonesia BCA Kemang 1, Account No. 286 301 7564 Swift Code: CENAIDJA Bank Address: BCA Kemang 1 Jl. Raya Kemang No 60 Jakarta Selatan 12060 Message: SII2015 + Participant’s Full Name Registration is only completed after proof of transfer is received and registration form submitted. My signature below signifies understanding and acceptance of the terms listed in the SII2015 program course. Date Name of childattending Institute Signature of Parent/Guardian (required) ____________________________ _________________________________