Special Plaque Enrollment Card
(Early Bach, Advanced Bach, Sonatina, Sonata, Founder)

Please list names, type of plaque, and grade received ("C" over "A") for pupils who wish to apply for the special plaques (Early Bach, Advanced Bach, Sonatina, Sonata, Founder). Return this card with the fee of $20.00 per plaque, and a copy of each pupil's audition report card, stub and pre-approval form (by July 1 if you wish publication in Piano Guild Notes). The application fee of $20.00 includes the cost of the plaque but is not payment for express mail handling.

(Please Send After Auditions)

 NAME OF PUPIL          TYPE OF PLAQUE   GRADE (C/A) FEE

1._________________________________________
2._________________________________________
3._________________________________________
4._________________________________________
5._________________________________________
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7._________________________________________
8._________________________________________
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10.________________________________________
11.________________________________________
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15.________________________________________
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20.________________________________________

                      Total Fees $________

Name of Teacher:___________________________
Address:___________________________________
City/State/Zip:________________/___/_______
Email Address:__________________________________

American College of Musicians
Box 2215, Austin, Texas 78767-2215

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Please Print this page out and mail it to us.
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